Name *


Address *


City - Zip *


Country *


Nationality *


Date and birth place *


Sex *
Male Female

Mobile phone *


Email *


Driving licence nr. *


Date and place of issue *


2009 FIM international licence *


Prefered race number


Team


Nr of people in team ( accompanying people use seperate form ) *
1 2

Race bike *
I rent via Quantya DK ( Pro I class ) I buy via Quantya DK ( Pro I class ) I bring my own Quantya ( Pro I class ) I bring my own Zero MX ( Pro II class ) I bring my own bike of different make ( Proto class )

I will bring my own transponder *
yes
no

Staying *
I would like to stay in a camper ( included in entry fee ) I bring my own camper ( included in entry fee ) I stay in a hotel at my own expense