Clone of MODULO DI ISCRIZIONE ARTUGNA 2026

Clone of MODULO DI ISCRIZIONE ARTUGNA 2026

ENTRY FORM
Any entries that are incomplete or do not provide proof of payment will be considered INVALID.

LICENCE No.*
NAME or COMPANY NAME*
LICENCE

Cancelof

Name*

NameSurname
LICENCE No.*
Date of Birth*

GiornoMeseAnno
Place of birth*
Address*

Address

Address 2

CityCountry / Province

Postcode
Telephone number*
Please enter a valid telephone number.
Email*
esempio@esempio.com
Driving licence*

Cancelof
Licence*

Cancelof

Name*

NameSurname
LICENCE No.*
Place of birth*
Date of birth*

MeseGiornoAnno
Data
Address*

Address

Address 2

CityCountry / Province

Postcode
Telephone number*
Please enter a valid telephone number.
Email*
esempio@esempio.com
Driving Licence*

Cancelof
Licence*

Cancelof

NAME
LICENCE No.
Licence

Cancelof

MAKE *
MODEL*
TECHNICAL PASSPORT No.*
GROUP and CLASS*
GRUPPO OPEN

OPEN CCROPEN STORICO (RALLY)OPEN RALLY

The fees are inclusive of VAT
The entry fee includes a 70 m² service area, a service plate, tracking, insurance, and recycling.

Payment must be made no later than 09.03.2026.

Any payment after this date will be considered as payment on site (150%).

All entry fees must be paid into the following bank account (EUR):

Banca di Credito Cooperativo Pordenonese

TOP SRL

IBAN: IT 78I 08356 12503 000 000 131002

SWIFT / BIC: ICRAITRR9W0

CAUSALE: ARTUGNA 2026 and the full name of the driver.
PROOF OF PAYMENT*

Cancelof

Area requested (m X m)
The entry fee includes a 7m x 10m area.
Service near:

COMPETITOR
require

to be authorized to use on board cam era during the eve nt after verification of assembly by the Scrutineers
Delcares furthermore, NOT to modify the positioning, the support structure and the fixing of the on board camera during the race, expressly exonerate the Organizer, the Race Officials and ACI Sport fro m any liability deriving from failure to comply with this commitment.

NAME or COMPANY NAME*
Address*

Address

Address 2

CityCountry / Province

Postcode
Telephone number*
Please enter a valid telephone number.
Email / PEC*
esempio@esempio.com
VAT NUMBER / TAX CODE*
SDI CODE (Only for VAT numbers)

Signature COMPETITOR

Svuota
DRIVER signature

Svuota
NAVIGATOR signature

Svuota
Should be Empty: