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Championkart International Final 2011

- The document is an identification form and equipment declaration for the CHAMPIONKART INTERNATIONAL FINAL 2011 race taking place October 8-9, 2011 in Jesolo, Italy. - It collects personal information about the driver such as name, license number, address, contact details, as well as information about the karting equipment being used such as chassis, engine, and tires. - The driver and entrant declare that they will follow all rules and accept responsibility, and authorize Markspeed Race to use their personal data in accordance with privacy laws.

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Mario Motica
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42 views2 pages

Championkart International Final 2011

- The document is an identification form and equipment declaration for the CHAMPIONKART INTERNATIONAL FINAL 2011 race taking place October 8-9, 2011 in Jesolo, Italy. - It collects personal information about the driver such as name, license number, address, contact details, as well as information about the karting equipment being used such as chassis, engine, and tires. - The driver and entrant declare that they will follow all rules and accept responsibility, and authorize Markspeed Race to use their personal data in accordance with privacy laws.

Uploaded by

Mario Motica
Copyright
© Attribution Non-Commercial (BY-NC)
We take content rights seriously. If you suspect this is your content, claim it here.
Available Formats
Download as DOC, PDF, TXT or read online on Scribd

Code

0000000000000000

Transponder

CHAMPIONKART INTERNATIONAL FINAL 2011 PISTA AZZURRA JESOLO (VE), 8-9 OTTOBRE 2011 IDENTIFICATION FORM AND DECLARATION OF EQUIPMENT

Entrant Driver number City Phone Number Grado LicenzaLicenza


Licence grade - Team

Licence Number Category Race

SIX AddressSPEED
Poste Code Country Fax Number Data Scadenza Certicato E-mail Data nascita Karting Club
Date of Birth
>8 years old

Mobile
Karting Club

Licence Number

Medical Certificate

According to the rules is going to attend the race with the following equipment:

Chassis: Make - Model CHAMPIONKART SIX SPEED Engine: Make - Model Tyres: Slick / Rain Oil: Make - Model %
Declare:
- to know and to accept the National Karting Rules and its additional rules, the Particular Race Rules, the Championkart Sporting and Technical Rules and to release Markspeed Race from any Civil and Penal responsability; - to own an ACI-CSAI licence and a medical certificate with current validity; - to ware the obligatory security equipment (racing suit, gloves, helmet...) as per the National Karting Rules; - to take part to the sporting check; - to accept without conditions the consequences in taking part in sporting kart activities and its rules, - to refrain from issuing public statements which may injure sport and its proceeding; - to keep always a fair play behaviour; - to respect decisions and rules of qualified people who control motorsport; - to have knowledge of the identifing number and to stick the bar code label recieved during sporting check on the chassis and the engine; - to take care about the transponder received and to be responsible of it in case of damages or loss.

TM K9B ES 125CC VEGA SL4 / VEGA W5 CIK

Mechanic 1 - Licence

Mechanic 2 - Licence

are delegated and authorized to represent the Entrant and the Driver during technical checks. The Entrant and the Driver authorize Markspeed Race to treat the personal data given respecting the Legislative Decree n196/2003. The personal data are collected both through a manual way of proceeding and through an automated one, also with the aid of electronic tools (computer and/or telex) directly and/or by delegated third party to communicate promotional activities, to send information and advertising material even through telephone, fax, e-mail, sms, mms according to CSAI or Championkart purposes.

CLOSING DATE OF ENTRIES: 04.10.2011 THE PRE-REGISTRATION AND THE PAYMENT OF THE ENTRY FEE ( 230,00) ARE MANDATORY Account number for the bank transfer: Banca Popolare di Vicenza - iban IT 54 W 05728 61570 162570392772 - bic BPVIIT22162 Benificiary name: MARKSPEED RACE The entry form and the copy of the bank payment must be sent to our offices (by e-mail or fax) not later than the closing date (4 october 2011); failing that, the payment will be carried out on the spot. e-mail: [email protected] / fax: +39 0423 760156
For new registrations please send also a copy of the licence.

For Extra European Country drivers please send also the VISA
Organization : Markspeed KC Via Molinare 13F 31030 C. di Godego TV [email protected] cell +39 335 6266636 fax +39 0423 760156

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