Via Flaminia Classic, May 19 – 26, 2018 Registration Via Flaminia Classic, May 19 – 26, 2018 Fields with an * are mandatory First driverName*Gender*Mr.Ms.Address* Street Address City ZIP / Postal Code AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAntigua and BarbudaArgentinaArmeniaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBrazilBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFaroe IslandsFijiFinlandFranceFrench PolynesiaGabonGambiaGeorgiaGermanyGhanaGreeceGreenlandGrenadaGuamGuatemalaGuineaGuinea-BissauGuyanaHaitiHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiNorth KoreaSouth KoreaKosovoKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMauritaniaMauritiusMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew ZealandNicaraguaNigerNigeriaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPolandPortugalPuerto RicoQatarRomaniaRussiaRwandaSaint Kitts and NevisSaint LuciaSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSpainSri LankaSudanSudan, SouthSurinameSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.YemenZambiaZimbabwe Country Mobile Nr. while on the rally*Place and date of birth 1)*E-mail address* Enter Email Confirm Email Your dress size*SMLXLXXLPlease upload a profile photo (max 3MB)Accepted file types: jpg, gif, png. Second driverName*Gender*Mr.Ms.Address* Street Address City ZIP / Postal Code Mobile Nr. while on the rally*Place and date of birth 1)*E-mail address* Enter Email Confirm Email Your dress size*SMLXLXXLPlease upload a profile photo (max 3MB)Accepted file types: jpg, gif, png. Phone number of relatives/friends in case of emergency:Phone number of relatives/friends in case of emergency CarCar make and model*Year of first registration*Please also send a digital picture of your carAccepted file types: jpg, gif, png. For those taking the motorail:Height of the car in cm (lower deck: 156 cm; upper deck: 186 cm)License plate numberLength of the car in cmDoes the car have a soft top ?YesNoHow did you learn about the Via Flaminia ? RegistrationVia Flaminia Classic: May 19 - 26* We want to participate in the Via Flaminia Classic from Verona to Lecce: May 19 - 26 Registration fee*€ 3.300, - Registration for a crew of two (last entries)Sport or Tour Class*Tour ClassSport ClassYour booking is confirmed on the moment of reception of the full amount of the rally sum.Upgrade Upgrade (you come on top of the list for the best rooms). € 300, -. NB: It is advisable to have a cancellation insurance in case you cancel the event, see the refund policy.NB: The Via Flaminia is subject to the ruling travel agencies and therefore no VAT is applicable. For owners of a business You can become a Participating Sponsor of the Via Flaminia. You will be getting an invoice with VAT mentioning, “cost advertisement”. In return you will be getting discount on the entry fee. You will also be mentioned on the website and on the road books. Please send the logo of your company.I am interested in becoming a participating sponsor I am interested in becoming a participating sponsor Participating sponsor We want to become a Participating Sponsor for € 1.200, (ex VAT) and get a discount of € 1.000, We want to become a Participating Sponsor for € 1.800 (ex VAT) and get a discount of € 1.500 Please upload the logo of your company (max 5MB)Accepted file types: jpg, gif, png, pdf, psd. TransportationDüsseldorf to Verona We will be using the motorail from Düsseldorf to Verona Shared Couchette or private Coupé (2017 prizes)€ 620, - Air conditioned shared Couchette€ 880, - Air conditioned private Couchette (4 beds)€ 920, - Air conditioned private Cabin with washbassin. € 70, - Dinner for two on the diner coach Flight Your car will be picked up on Saturday May 26 in the afternoon at the Airport. We ask you be there in time and book your flight accordingly.We want the car to be shipped back from Puglia. We want the car to be shipped back from Puglia. Shipping of the car€ 700, - Back from Bari Airport€ 780, - Back from Brindisi Airport (only for 7 or 8 cars) ConditionsConditionsGeneral conditions - The rallies have a limited amount of entry positions. The allocation will be on a first pay first served basis. - You need to appear with a car conform the age limitations of the specific rally you participate in. In case of a last minute breakdown of your car, you may bring a replacement car. If that does not meet the age requirements, then you participate hors concours. - If four months before the scheduled start of a rally, more than one third of the maximum of entry positions is still empty, then the organisation may cancel the rally. - The organisation reserves the right to bring in minor changes into the program. Refunds - If the event will not take place due to force majeure € 100, - will be restituted. Force majeure would be the car train ending operation or Italy closing its borders etc... - In all other circumstances where the organization cancels the event, a total refund will be given. - In the event you cancel your registration up to four months before the start of the rally a fee of 20% of the total booking fee will be held back. A cancellation between four and two months prior to the rally will result in 50% of the total booking fee being held back. If you cancel less than two months before the rally, then no refund is possible. The driver and his passenger(s) agree to the followingAll boxes should be checked to submit this formAgree lijst voorwaarden* Undersigned declare that they are physically and mentally fit to take part in the event and are competent to do so. Undersigned understand the nature and type of the event and the potential risk inherent with motor sport and agree to accept that risk. The persons driving the vehicle are in the possession of a driver's license valid in the countries, which the rally will cross The participants shall be held responsible for any breach of laws and regulations in which they may be involved. Undersigned declare that they realise that the Via Flaminia is going into serious mountainous terrain, that the brake fluid of the car has been changed not more than two years ago and that the brakes have been checked and are in perfect condition. Undersigned further declares that the car is well maintained, in good overall condition and complies with all regulations on roadworthiness. By applying to the Via Flaminia the applicant and his passenger(s) agree to indemnify and hold harmless the organisers of the event and all other bodies or companies and individuals associated with or participating in the event (and their respective employees and agents) against all proceedings, damages, liabilities, costs and expenses arising out of any act, default, negligence or breach of statutory duty on our part. The applicants declare to have a valid insurance covering them against liability for both personal injury to, and damage to the property of third parties on public roads. The vehicle entered will be covered by valid insurance for third party liability by law while driven by any member of its crew during any part of the event. Undersigned understand that Via Flaminia mediates in the transport of the cars and participants and that Via Flaminia is in no way responsible for delays, cancelations or damage occurred during this transport. In order to qualify for the registration fee, a full payment of the rally sum is needed, transportation can be payed two months before the rally. Undersigned state that they will make the payment to bank account IBAN: NL90INGB0009597908 BIC: INGBNL2A of Via Flaminia B.V. in Amsterdam. Via Flaminia B.V. is registered under number 34140031 of the Dutch Chamber of Commerce. By submitting this form you want to participate to the Via Flaminia 2018 and confirm to have read and understood the conditions and agree to them. CommentsThis field is for validation purposes and should be left unchanged. This iframe contains the logic required to handle Ajax powered Gravity Forms.