‫ﻧﺎدي اﻟﺴﻴﺎرات اﻟﺴﻮري‬

Syrian Automobile Club

11-13 June 2009
INDIVIDUAL ENTRY FORM
ENTRANT FIRST DRIVER CO-DRIVER
Team Name
Family Name
First(given) Name
Date of birth
Nationality (as passport)
Postal address
Passport Number

Address for correspondence(1,2 or 3) 1. 2. 3.

Telephone No. (business)
Telephone No. (private)
Mobile Tel. No.
Fax No.
E-mail address
Competition license No.
Issuing ASN
Driving license No.
Country of issue
DETAILS OF THE CAR
Make Registration No.
Model C.C.
Year of manufacture Body No.
Group / Class Engine No.
Homologation No. Predominant color
Country of registration Tech. Passport No.

Type of entry Trade/Legal etc,

Private/Amateur
Organizer’s proposed advertising accepted:
Yes No

Entry Fees
(For this entry form to be valid it must be accompanied by the appropriate entry fees .A receipt for the full amount with optional
advertising proposed by organizers paid to the entrants ASN , a bankers drafts or details of bank transfer etc..)

Entry Fees WITH the optional advertising proposed by the organizers

ENTRY/FEES PRIVATE/AMATEUR OTHERS CLOSING DATE
Reduced rate 500$ 1000$ 24:00hrs on 9 may 2009
Normal rate 900$ 1800$ 24:00hrs on 25 may 2009

Entry Fees WITHOUT the optional advertising proposed by the organizers

Entry/FEES PRIVATE/AMATEUR OTHERS CLOSING DATE
Reduced rate 800$ 1600$ 24:00hrs on 9 may 2009
Normal rate 1400$ 2800$ 24:00hrs on 25 may 2009
 SEEDING INFORMATION

First driver…………………… car………………………….. Group class…………

FIA priority A YES/NO previous FIA seed YES/NO

FIA priority B YES/NO if yes, year ……….
National seed YES/NO priority ……….
National championship
Winner? YES/NO if yes, championship………… year…….

year Event Car Group O/A Class No. of

position position finishers
International
National
Other

DECLARITION OF INDEMNITY
I have read and understood the regulation issued for this event and agree to be bound by them and by the
international sporting code the FIA. In consideration of the acceptance of my entry or of my being
permitted to take part in this event , I agree to save harmless and keep indemnified , the Syrian
Automobile Club and all sponsors together with such persons who are responsible for the organization of
the event and the receptive officials , servants , representative , employees and agents from all against
actions , claims, costs expenses , and demands in respect of injury or death to my self , or any of may
team members , and/or loss damage to my property howsoever caused arising out of or in connection
with my entry or taking part in this event , notwithstanding that the same may have been contributed to
or occasioned by the negligence of the said bodies their officials , employees , servants , representatives
or agents .

ACKNOWLEDGEMENT AND AGREEMENT:

By my signature I declare that all the information contained on the entry form is correct and that I acknowledge
and agree in full to the terms and conditions of the above indemnity and that I accept all the terms and
conditions relating to my participation in this event and I accept all the terms and conditions mentioned in the
supplementary regulations.

ASN Stamp* Signature of Entrant Signature of 1st Driver Signature of co-driver

Or letter from the entrant’s ASN authorizing and approving the entry
Date………………………………