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ENTRY FORM

40 ο INTERNATIONAL RALLY LARISSA - KALAMPAKA - METSOVO SEPTEMBER 2 1 -2 5, 201 1. ENTRY FORM. DRIVER. CO- DRIVER. FIRST NAME. LAST NAME. ADDRESS. MOBILE No. EXTRA PERSONS. CAR DETAILS. MAKE. YEAR. ENGINE CAPACITY. TYPE. FIVA CARD No. REGISTRATION No. EXTRA DISTANCE

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ENTRY FORM

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  1. 40οINTERNATIONAL RALLY LARISSA-KALAMPAKA-METSOVO SEPTEMBER 21-25, 2011 ENTRY FORM DRIVER CO- DRIVER FIRST NAME LAST NAME ADDRESS MOBILE No EXTRA PERSONS CAR DETAILS MAKE YEAR ENGINE CAPACITY TYPE FIVA CARD No REGISTRATION No EXTRA DISTANCE MEASURING DEVICES. YES NO APPLICATION DEADLINE :AUGUST 19,2011 BANK ACCOUNT No : ALPHA BANK: 11600 200200 6081 ΙΒΑΝ: GR27 0140 1160 1160200 2006 081 PIRAEUS BANK: 5069-037331-684 ΙΒΑΝ: GR900172 0690 0050 6903 7331 684 ENTRY FEE : 650€ for entries received until 31 July 700€ for entries received after 1st August Includes: A four nights stay in luxury Hotel,Meals during the 3 days of the competition Gala dinner of Saturday September 24,2011 Car insurance –Expenses of organization.

  2. PLEASE GIVE US DETAILS FOR HOTEL RESERVATION (NUMBER) SINGLE ROOM DOUBLE ROOM THREE BEDROOM SIGNATURE DATE……/…..2011 PHILPA – The Antique Car Club of Greece 92, Pindou St., 15669 Papagou, Attiki, Greece.Tel.: 0030 210-6534700,Fax: 0030 210-6533420 e-mail: info@philpa.gr

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