Driver

 

 

 

 

Start no. request

 

First name *

 

Last name *

 

Address *

 

Post code *

 

Town *

 

Country *

 

E-mail *

 

Phone no. *

 

Mobile phone *

 

Website

 

Licence class + no. *

 

Personal ID no. *

 

Club (on licence) *

 

Nationality *

 

Car make / model *

 

required fields *

 

 

 

Class

Supercar  *

Supercar Lites *

CrossCar *

CrossCar Junior *

Open 2WD *

* one class option has to be filled in

 

 

Transponder

I have my own transponder  *

with no. *

 

I don't have my own transponder *

 

For more information or to order contact Meik Wagner +46 70-428 9936 or info@mwraceconsulting.com

* one transponder option has to be filled in

 

 

Entrant (Entrants without ASN licence numbers will not be published on official paperwork)

Name

 

ASN Licence no.

 

Championship / Events

 

Complete series

 

Nysum 1-2 May

Höljes 13-16 May

OuluZone 5-6 June

Arvika 13-15 August

Championship fee  for complete series Supercar SEK 48 000:- / single events SEK 15 000:- / single entry Arvika 8 000:- + 6% tax

Championship fee  for complete series Supercar Lites SEK 48 000:- / single events SEK 15 000:- / single entry Arvika 8 000:- + 6% tax

Championship fee  for complete series CrossCar SEK 28 000:- / single events SEK 8 500:- / single entry Arvika 5 000:- + 6% tax

Championship fee  for complete series CrossCar Junior SEK 18 500:- / single events SEK 5 500:- / single entry Arvika 3 500:- + 6% tax

Championship fee  for complete series Open 2WD SEK 28 000:- / single events SEK 8 500:- / single entry Arvika 5 000:- + 6% tax

Entries to individual competitions will be accepted on the basis of space.

Championship fee will be invoiced by RX Promotion AB

Enter the invoice recipient

Name *

 

Address *

 

Post code *

 

Town / Country *

 

Organisation no.*

 

VAT no.*

 

required fields *

 

Team

 

 

 

Name

 

(Notice! Team name will be shown during the TV broadcast)

Paddock information

 

 

 

Total surface for service vehicle + service tent

width *

 

metres

length *

 

metres

Additional information

 

(like sharing paddock space with other drivers, etc.)

 

 

 

 

 

 

Extra electricity (ORDER)

 

 

 

 

 

 

400 V 16 A

quantity

 

 

 

 

 

 

 

400 V 32 A

quantity

 

 

 

 

 

 

 

Electricity included in the entry fee is 1 pcs. 230 V 10 A for all classes per competitor

Electricity which is not ordered in this entry form can not be guaranteed

required fields *

 

 

 

 

 

 

 

Contact person for team/driver (Notice! Person responsible for all communications relating to the series promoter and all events)

Name *

 

E-mail *

 

Mobile phone *

 

 

 

required fields *

 

 

 

I HAVE READ AND AGREE TO BE BOUND BY THE PRIVACY POLICY AS WELL AS ALL SPORTING, COMMERCIAL AND PADDOCK REGULATIONS *

Regulations RallyX Nordic 2021

required fields *