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Online Entry Application Form



Club 1000 Miglia Franco Mazzotti
Address: Via Enzo Ferrari, 4/6 - 25134
City or town: Brescia BS
Italy
Tel: 030 2397322
Fax: 030 2397322
segreteria@clubmillemiglia.eu
Orari di Apertura della segreteria: dal Lunedi al Venerdì dalle 9.30 alle 12.30
* Mandatory fields

Driver's Name*

Driver's Surname*

Driver's address*

Driver's City*

Driver's zip code*

Driver's Country*

Driver's Date of Birth*

Driver's Place of Birth*

Driver's Licence n°*

Driver Licence's Date and place of Issue*

Driver's Size*

Driver's Email*

Driver's Mobile Phone*

Driver's class*

Co-Driver's Name*

Co-Driver's Surname*

Co-Driver's Address*

Co-Driver's City*

Co-Driver's Zip Code*

Co-Driver's Country*

Co-Driver's Date of Birth*

Co-Driver's Place of Birth*

Co-Driver Licence's N°*

Co-Driver license's Date and place of issue*

Co-Driver's Size*

Team*

Car Brand*

Car Type/model*

Car Cylind.cc*

Car Year*

Car Chassis N°*

Type and N° Fiche (FIVA,ASI,CSAI etc)*

Car Plate*

Car Insurance*

N°Insurance*

Car Insurance expiration date*

Full participation of two people to the Race, overnight stay in a double bedroom, 2 lunches 1 dinner, “aperitivi” and gadgets

690,00 €

Participation to the Race without overnight stay, with breakfast, “aperitivi”, lunches, dinner and gadgets, for two people

600,00 €

Participation to the Race without accomodation and without gifts

250,00 €

Supplement for overnight stay in 2 single bedrooms

60,00 €

Overnight stay in a double bedroom for two people Friday night

120,00 €

Supplement for overnight stay in single bedrooms Friday night

60,00 €

1 Host companion to the race with overnight stay in a single bedroom, 2 lunches , “aperitivo” and dinner Saturday night

380,00 €

2 Host companion to the race with overnight stay in a double bedroom, 2 lunches , “aperitivo” and dinner Saturday night

620,00 €

Hosts lunch and awards ceremony Sunday at Ghedi Military Airport

65,00 € for 1 person
130,00 € for 2 people

Hosts “aperitivo” and dinner Saturday night

60,00 € for 1 person
120,00 € for 2 people
A maximum of 120 vehicles will be accepted. Club Mille Miglia reserves at its own discretion the acceptance of the application form. N.B. Invoice will be issued only if required together with the application form (attached to billing information).



APPLICATION FORMS THAT RESULT BEING INCOMPLETE OR NOT ACCOMPANIED BY THE RELATED FEE WILL NOT BE CONSIDERED VALID.



Registration fees must be sent to the organization WITHIN THE CLOSING DATE FOR APPLICATIONS as follows:

1) Submitting the registration THROUGH RECORD DELIVERY LETTER, attaching a NON-TRANSFERABLE CHEQUE registered to A.S.D.CLUB MM

2) Registering through this form on the website and paying by bank transfer as shown below.

3) Submitting the REGISTRATION via FAX (030/2397322) or by email to segreteria@clubmillemiglia.eu attaching a copy of the bank transfer made for A.S.D.CLUB MM.



DETAILS FOR THE BANK TRANSFER



UBI BANCA - Registered office of Brescia -

IBAN: IT11P0311111238000000065181 - BIC SWIFT: BLOPIT 22
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send a copy to my email address

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