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Inschrijfformulier

Home » NK 2-takt » Inschrijfformulier

Entry Open Winter 2T Serie 2019

If you are human, leave this field blank.

Date Open Winter 2T serie

13 January 2019 - Circuit erftlandring kerpen

10 February 2019 - Circuit park Berghem

Subject to bad weather conditions

Class:

Micromax

Minimax

Max junior

Max senior

KZ2

KZ2 plus

Name: *

Address: *

Zip code: *

Place: *

Country: *

Telephone number:

Email: *

Date of birth: *

Starting number:

(preference)

Brand:

Transponder number:

(in case of possession)

Would like an invoice:

Yes

No

Invoice address:

In case wanted

(KNAF) ASN licence 2019: *

Yes

No

Licence number 2019:

(in case of possession)

(KNAF) Ouder/kind licentie / entrant licence:

(only for drivers under 18 years)

Pay both races at ones:

Yes

No

Discount payment of both races at ones

I agree with the conditions of participations:

Yes

No

Bezig met versturen

Deelnemers voorwaarden

Contact Organisatie

Gaby van de Burgt
Chrono Karting BV
Mensfortweg 24
5627 BR Eindhoven
+31 (0) 6 53 81 44 37
gaby@chrono.nl

Contact Techniek

Ton van de Burgt
+31 (0) 6 53 13 92 04
ton@chrono.nl

Bankgegevens

IBAN: NL40ABNA0456480773

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