Via Hellenica 2017, September 18 – 27 Registration Via Hellenica 2017, September 18 – 27 Fields with an * are mandatory First 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 You will be getting a jacket.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 You will be getting a jacket.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:Hight 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 Hellenica Classic: September 18 - 27* We want to participate in the Via Hellenica Classic: September 18 - 27 Registration fee:*€ 4.440, - Registration for a crew of two.€ 230, - upgrade € 230, - Upgrade (you come on top of the list for the best rooms) 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. TransportationWe will be using the motorail:Düsseldorf and/or Verona from Düsseldorf to Verona € 620, - Air conditioned shared Couchette.€ 880, - Air conditioned private Couchette (4 beds).€ 910, - Private cabin for 3 with washbasin.€ 70, - Dinner for two on the diner coach (first serving) € 70, - Dinner for two on the diner coach. Verona to Düsseldorf from Verona to Düsseldorf € 540, - Air conditioned shared Couchette.€ 730, - Air conditioned private Couchette (4 beds).€ 750,- Private cabin for 3 with washbasin.€ 70, - Dinner for two on the diner coach (second serving) € 70, - Dinner for two on the diner coach (2016 price) We will be using the ferry: from Ancona to Patras from Igoumenitsa to Ancona We ask you to book yourself with ANEK. As participant to the Via Hellenica, you will be getting a discount of 30%. 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 resituated. 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 Hellenica 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 Hellenica 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. 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 Hellenica 2017 and confirm to have read and understood the conditions and agree to them. NameThis field is for validation purposes and should be left unchanged.