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1-2 SEPTEMBER 2023

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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

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

Driver BRC

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 (*)

Co Driver BRC

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

Car

Make Model Year of manufacturing Class / Group Homologation No Country of registration

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 05/08
23h59		 after 05/08
23h59
Private test 13h30-17h30
UPON INVITATION - INCL SHAKEDOWN		 + € 300
YES
NO 		SHAKEDOWN SLYPS
18-22u		 + € 150
YES
NOI 		OUVREUR + € 300
BRC RC2 - RGT € 1750 € 1850
BRC RC1-RC3-RC4-RC5-NAT € 1300 € 1400
BRC Historic € 1300 € 1400
BRC Junior RC4-RC5 € 900 € 1400
BRC 2WD € 900 € 1000
M Cup € 900 € 1400
Clio Trophy € 900 € 1400
Stellantis Cup € 900 € 1400
HRCR Mini Sport Cup (UK) € 900 € 1400
No publicity € 3000

Closing date 24/08/2022 23u59

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 « 62° A&D Omloop van Vlaanderen 2022 », 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