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3-4 SEPTEMBER 2021

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Godderis

Entries

ENTRY

To submit a valid entry, please fill in this form completely. The fields marked with (*) are mandatory, to register online, we require an email address on which we can contact you. Please sign (driver and co-driver) the received entry form and bring this to the administration control on Friday.

Entrant BRC / CRITERIUM

Team (*)
Name
Prénom
Nationality of the Licence
Address for correspondence (street/nr)
Zip Code
City
Email
Mobile phone number (*)
Licence number
Sport National Authority

Co Driver BRC / CRITERIUM

Name
First Name
Date of birth
Nationality
Street + housenumber
Zip Code
City
Email
Mobile phone number
Paspoort No
Drivers licence
Country of issue
Licence number
Sport National Authority
In accordance with articles 3.2.1, 23.2 and 41.3.5 of the BRC 2021 Sporting Regulations, I confirm that my participation in this competition will NOT TAKE IN THE POINT AWARDS for my ranking in the Belgian Rally Championship.
Junior BRC
BRC

Car

Registration No Real cylinder volume Body No Motor No Predominanr colour Technical passport No

ENTRY FEES

For this entry form to be valid it must be accompanied by the appropriate entry fees.

KBC / Code IBAN: BE43 4676 3593 3101 / Code Swift (BIC) KREDBEBB

before 06/08
23h59
after 7/08
00h00
SHAKEDOWN
18-22u
+ € 100
BRC € 1750 € 1850
BRC Historic € 1750 € 1850
TER € 1750 € 1850
TER Historic € 1750 € 1850
PORSCHE EVENT € 1750 € 1850
M CUP € 850 € 1600
Renault Clio Cup € 850 € 1600
Stellantis Cup € 850 € 1600
Volvo Euro Cup € 850 € 1600
MINI SPORT CUP € 850 € 1600
STAGE MASTERS € 850 € 1600
CRITERIUM € 500 € 600
NO PUB € 3000
€ 1000 Criterium

Closing date 24/08/2021 24u

SEEDING INFORMATION

FIA priority A driver
YES
NO

FIA priority B driver
YES
NO

Previous FIA seed
YES - Year NO

National seed
YES - Priority NO

National championship winner
YES - Year NO

FIRST DRIVER'S RESULTS

To be able to easily consult your results, we ask you to insert the link to your profile page on EWRC.

DECLARATION OF EXEMPTION OF RESPONSIBILITY

By the fact of its engagement, any competitor, driver or another licence holder exonerates the RACB, the RACB Sport, the organizers and their representatives, employees and each one of them in particular, from any responsibility in connection with the actions, expenses, fees, claims and complaints relating to the wounds (mortals or others), losses and damage caused with its person, with its goods, whatever the cause coming or resulting from its engagement or its participation in the « 61° Omloop van Vlaanderen 2021 », that it is or not the direct or indirect consequence of a negligence or a fault of the aforesaid organizers, their representatives or their employees.

By ma signature I declare that all the information contained in 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.

CONFIRM