REGISTRATION 2015

REGISTRATION 2015
Driver:
Driver’s name:
Date of birth:
Licence no.:
Licence grade:
Country of residence Motorsports Club:
Drivers address:
Post code:
City/Country:
E-mail:
Phone (day):
Phone (evening):
Entrant/Sponsor/Team Name (max. 3 words):
Particulars of Car:
Make:
Model:
Engine:
Cc:
No. of cylinders:
Registration for BOSS GP class:
❏ BOSS GP “OPEN”
❏ BOSS GP “FORMULA”
❏ BOSS GP “MASTERS”
Preferred competition car number:
BOSS GP Open class: 1-10
BOSS GP Formula class: 11-40
BOSS GP Masters class: 41-99
(Numbers 1, 11 and 41 are reserved and will be assigned by the series coordinator only!)
Does driver have any disability or is driver taking any Prescribed drugs
which should be notified to Circuit Medics:
I wish to register for:
❏ All events
❏ Yes
❏ No
❏ Single events
If option ‘Single events’ is selected, please confirm which events registration is required for:
Round
Date
Circuit
Event
1
11-12 April
Hockenheim GP (GER)
Hockenheim Historic
2
02-03 May
Paul Ricard (FRA)
FFSA Historic Tour
3
23-24 May
Monza (IT)
TCR International Series
4
20-21 June
Zolder (BEL)
Syntix Superprix
5
01-02 August
Assen (NL)
GAMMA Racing Day
6
05-06 September
Brno (CZ)
FIA ETCC & Auto GP
7
03-04 October
Dijon (FRA)
Motors Cup
BOSS GP Registration 2015
Registration required for
❏
❏
❏
❏
❏
❏
❏
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REGISTRATION 2015
Series registration fee:
Payment term:
350 Euro excl. 21 % Dutch VAT.
th
The series registration fee is due for payment the 29 of March 2015.
Season entry fee:
Payment term:
11.000 Euro excl. 21 % Dutch VAT.
th
50 % of the season entry fee is due for payment the 29 of March 2015.
st
Rest 50 % is due for payment the 1 of June 2015.
Invoice address:
Bank details:
Account holder: Stichting BOSS GP
❏ Same as “Drivers address”
❏ Private
❏ Company
IBAN: NL68 RABO 0155 9747 34
BIC/Swift-code: RABONL2U
Name:
Address:
Post code/Town:
Country:
VAT-no.:
I wish to register for BOSS GP 2015 and I declare that the information given above is correct.
I understand that should the above information change in any way I will confirm details in writing to the Stichting B.O.S.S. GP
race management as detailed below.
Date and Drivers signature:
Date and Entrants signature:
Closing date for registration is the 29th of March 2015.
Please send registration to:
BOSS GP Series
c/o Christian Gaense
Schleizer Strasse 17
D-07955 Auma-Weidatal
Germany
Fax: +49 (0) 366 26 16 96 87
E-mail: [email protected]
For official use only
Date registration received:
Registration fee:
Date registration card sent:
Competition number allocated:
BOSS GP Registration 2015
Date received:
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