Registration Peaks of the Caucasus, 1 – 14 October, 2018 Registration Peaks of the Caucasus, 1 – 14 October, 2018 Fields with an * are mandatory First driver Name*Gender*Mr.Ms.Address* Street Address City ZIP / Postal Code AfghanistanÅland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarrussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongo, Democratic Republic of theCongo, Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCuraçaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatini (Swaziland)EthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacauMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRéunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth GeorgiaSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan Mayen IslandsSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUS Minor Outlying IslandsUzbekistanVanuatuVenezuelaVietnamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe 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.Please upload a copy of your passport (max 3MB). Your passport needs to valid for at least 3 months upon arrival.*Accepted file types: jpg, gif, png, pdf. 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.Please upload a copy of your passport (max 3MB). Your passport needs to valid for at least 3 months upon arrival.*Accepted file types: jpg, gif, png, pdf. 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.License plate number*Length of the car in cm*Height of the car in cm*How did you learn about the Peaks of the Caucasus ? RegistrationPeaks of the Caucasus, 1 -14 October 2018.* We want to participate in the Peaks of the Caucasus, 1 - 14 October 2018. Registration fee*€ 8.770, - Registration fee.Upgrade Upgrade (you come on top of the list for the best rooms). € 800, - . Your booking is confirmed on the moment of reception of a down payment of € 3.000, -.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 € 1.800, (ex VAT) and get a discount of € 1.500, We want to become a Participating Sponsor for € 3.000 (ex VAT) and get a discount of € 2.500 Please upload the logo of your company (max 5MB)Accepted file types: jpg, gif, png, pdf, psd. TransportationWe have choosen M Star Freight as our partner for the shipping. M Star has a large experience in shipping to and in the Caucasus. We would like to have our car shipped by container to Tbilisi and back. We would like to have our car shipped by container to Tbilisi and back. Pick-up and return location.€ 3.500, - From Antwerp (cars up to 4.50 m). *)€ 4.000, - From Antwerp (cars over 4.50 m). *)€ 4.350, - from Ipswich. *)*) This fare is based on the current geopolitical situation and might vary if transportation routes need to be changed.Transport Insurance€ 275, - Car with value up to € 50.000, - (own risk € 1.000, -)€ 400, - Car with value between € 50.001 and € 125.000, - (own risk € 1.000, -)€ 700, - Car with value between € 125.001 and € 250.000, - (own risk € 2.500, -)Car with higher value than € 250.000, - please inquire.We advise you to insure your car during shipment. The insurance includes general average insurance (insuring you against the cost of salvaging the ship if something happens). Flight We understand that it is too early for you to tell us now. Please tell us when you have booked. In any case, you are expected in Tbilisi on the morning of October 1.Flight number date and time into Tbilisi.Flight number date and time out of Tbilisi.Do you have any remarks or questions ? ConditionsConditionsGeneral conditions - The Peaks of the Caucasus rally has 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 - In case the geopolitical situation makes it wise or necessary to cancel the Peaks of the Caucasus, to be judged by the organization, then we will restitute the full amount minus the cost incurred at the moment of cancelation. - 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 Peaks of the Caucasus is going into serious mountainous terrain, that the brake fluid of the car (if applicable) 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 Peaks of the Caucasus 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 understand that a Third Party Insurance is included which covers up to $ 300.000, - in damages and which does not cover damage between participants. 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 retain an entry position a down payment of € 3.000,- is needed. The remainig is due by June 1, 2018. 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 Peaks of the Caucasus 2018 and confirm to have read and understood the conditions and agree to them. EmailThis field is for validation purposes and should be left unchanged.