Tip 1: print your completed entryform in double for reference data

The undersigned declares that he/she has read and understands the general conditions of participation and that he/she accepts them as such. He/she waives the right to make any claims for damages resulting from an event, be this against the organiser, race stewards, medical staff, the race track owner, sponsors, racing services or other parties involved in the organisation of the event, including the organiser’s agents and persons contracted by the organiser within its obligations. Truthfully filled in and signed d.d.

Tip 2: Select in print options the option for horizontal print version
and print the entryform complete in 2 pages.

You may also fill out this entryform on computer, print it and send it with
mail delivery to:

motoUP
Goorsestraat 79
NL - 7482 CC   Haaksbergen
Nederland

Fee           number of days

 
120,- euros

If you cannot make use of all the days you booked, because of a crash with injury, a damaged bike or other reasons during the event, the remaining days are not refunded. Please contact the organisation in this case.

box rental fee payment please at the track

Online inschrijving
L'inscription en ligne
Online registration
Online-Registrierung
Registrazione online
El registro en línea
Online registrace

* Obligatory

* You will receive an e-Mail within 72 hours with additional information
to complete your entry *

Please notice: when sending this form a contract is to be established
The contract is founded upon our terms of participation.
Please inform yourself before sending the entryform.

Name *


Date *


City *


Signature parent/tutor in case of entrant under 18 years of age

Name *

Relation

25.02. -- 27.02.2012       3 days         390,- euros                    510,- euros

25.02. + 26.02.2012       weekend      290,- euros                    370,- euros

26.02. + 27.02.2012       sun + mon   250,- euros                    330,- euros

sat         25.02.2012       1 day           150,- euros                    190,- euros      
sun        26.02.2012       1 day           170,- euros                    210,- euros    
mon       27.02.2012       1 day           130,- euros                    170,- euros    

Title *


Naam *


Surname *


Street address *


Postal code*


City *


Country *


Nationality *


Date of bitth *


Phonenumber *


Mobile phonenumber *


e-Mail *


Phonenumber in case of accident *


Relation to above tel. number *


Name mechanic / companion *


Mobile mechanic companion *


TVA nr

*e-Mail address for entries: entries@moto-up.com

Make and model / capacity


Type

Make and model


Type

I do ride motorcycles since (year)


mileage / year ( approx. )


track experience

year                                    laptime:                     min.                             sec.  

licensed rider since ( year)


type license 2010/2011/2012


category





team name

I do / do not have a health insurance for foreign countries

testing schedule
10.00 - 18.00 hrs in 3 groups

no lunchbreak

restaurant open 09.00 - 18.00 pm

paddock & registration open
24. february from 17.30 to 21.00 pm
25./26./27.   from 09.00 to 18.30 pm

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