OFFICIAL ENTRY FORM

	

NEZ SUPERCROSS 
EAL
Regati pst. 1-5P
11911, Tallinn, Estonia
Fax: +372 6398 553
E-mail: eal@sport.ee	

NEZ	

FIA NEZ CHAMPIONSHIP FOR SUPERCROSS (AUTOCROSS / RALLYCROSS) DRIVERS
ELVA 25.09 – 26.09  2004

	

ORGANIZER
Name      MTÜ Reinsalu Sport
Address   KONGUTA TEE 3, ELVA 
 ESTONIA
Phone  + 372 52 18 677  Fax +372 74 15 436
 e-mail    ahti.sei@mail.ee

(X)
	
1600 Junior	
	
2000 Super	
	
D1	

	

	

	

Open	

Buggy	

	

	

ENTRANT

Country ___________________________________
Name ____________________________________
Address  ___________________________________
 _________________________________________
Phone______________ Fax __________________

Start number  ______________________________
Driver’s name ______________________________
Licence No: __________
Entrant’s name ____________________________
Licence No: __________
Signatures	

	

DRIVER

Name ____________________________________
Address  ___________________________________
 _________________________________________
Phone______________ Fax __________________
Date of birth  ______________________________
Country __________________________________

               
                 Entrant ___________________
                 Driver    ___________________
                 Date      ___________________

STAMP
(national ASN)	

	

	

	

Mark _____________Model ___________Mark of engine ___________Capacity of engine (cm3)________ 
FIA Technical passport No ___________ Power(HP)_______________ Weight (KG)__________________