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	APPLICATION FORM
(Entry for all rounds of the DMSB Karting Championship 2019 mentioned below)

CHOOSE YOUR CHAMPIONSHIP:*

DKM (German Karting Championship) - OK
DJKM (German Junior Championship) - OK-Junior
DSKM (German Shifter Karting Championship) - KZ2
DSKC (DMSB Shifter Kart-Cup) - KZ2
DEKM (German Electric Karting championship)

With this application form Entrant and Driver entrust and authorize the DMSB or DMSW GmbH to submit on their behalf entries to all organizers of the competitions of the above selected DMSB Championship respectively DMSB Cup (block entry).

The complete application form must be personally signed by the Entrant as well as by the Driver (and possibly also by the legal representatives) latest during Sporting Check of the first competition.

The promoter of the respective championship or cup collects, processes and uses personal data in the course of the organization and processing of the competitions by means of electronic data processing. These are in particular the following data: names, addresses, date of birth, telephone numbers and e-mail addresses.
Publications in the frame of the competition (entry lists, participants’ lists, result lists, etc.) contain as personal data of Drivers and Entrants / Sponsors only Entrants name, Drivers last name, Drivers first name, nationality, license numbers and information on the material registered by these participants.
The participants (Entrants and Drivers) as contract partners of the promoter declare their consent to the aforementioned provisions by submitting this application for registration.

PLEASE COMPLETE ALL THE FIELDS BELOW

( * = for this marked field the completion is obligatory)

ENTRANT

Filling out the Entrant’s details is obligatory. The Entrant must be of legal age and holder of a valid international Entrant’s/Competitor’s licence.

ENTRANT’S NAME (consistent with licence):*

ENTRANT’S LICENCE NUMBER:*

ENTRANT’S ADDRESS

ZIP (Postal Code):*

City:*

Address (street+no.):*

Country:*

Name of team representative / team chief:*

Mobile phone number (incl. country code):*

Email‐address:*

DRIVER

Start number request:

Art. 2.5 of the DKM regulations must be observed (fee-based)!

LAST NAME:*

GIVEN NAME:*

DATE OF BIRTH:

LICENCE‐No.:

GRADE OF YOUR INT. KART LICENCE:

C-Junior C-Restricted C-Senior B-Senior A-Senior Int. D-Licence (exclusively DEKM)

DRIVER’S ADDRESS

ZIP (Postal Code):

City:

Address (street+no.):

Country:

Mobile phone number:

Email‐address:*

DMSB SPONSOR CARD

SPONSOR’S NAME (consistent with licence):

DMSB SPONSOR CARD NUMBER:

KART

CHASSIS MAKE:

ENGINE MAKE:

TYRES	DKM:	Slick tyres: VEGA XP Prime	Wet weather tyres: VEGA W5 Rain
	DSKM/DSKC:	Slick tyres: VEGA XM Prime	Wet weather tyres: VEGA W5 Rain
	DJKM:	Slick tyres: VEGA XH2 Option	Wet weather tyres: VEGA W5 Rain
	DEKM:	Slick tyres: VEGA XH2 Option	Wet weather tyres: VEGA W5 Rain

OWNER OF THE COMPETITON EQUIPMENT:

Please choose the valid situation:

The owner is:*

Entrant
Driver
Neither of them (please fill the next 3 fields)

Owner’s name or company:

Owner’s address (ZIP Code / City):

Owner’s address (street):

INFORMATION:
The owner specified here will sign the corresponding declaration of consent in the complete application form sent later.
If the vehicle owner does not give this consent or revokes it before taking part in the competition, participation of the following events after cancellation is not possible.
In the case of false statements, Entrant and Driver release the group of persons specified in the disclaimer of the kart owner from all claims of the kart owner with regard
to damages in connection with the event (= untimed and timed practice, qualifying practice, warm‐up, tests, races, heats). This applies also for costs of the kart owner
incurred in reasonably asserting his legal rights.

PLEASE NOTE:
This application request must be sent to the DMSB-DKM administration office (online) on 1st March 2019 at the latest. The registration/entry fee given below (includes the entry fee for all classification rounds) must be remitted to DMSW GmbH.

REGISTRATION / ENTRY FEES:

The registration fees are to be transferred after invoicing by the DMSW GmbH and before the first event and amounts (including entry fee and 19% VAT and including the "environmental and service charge" for each competition):

For receiving of online registration up to 01/03/2019:	2.600, ‐ Euro	for DKM (OK), DJKM (OK‐Junior) and DSKM (KZ2)
For receiving of online registration up to 01/03/2019:	2.300, ‐ Euro	for DSKC (KZ2)

For receiving of online registration later than the 01/03/2019:	3.000, ‐ Euro	for DKM (OK), DJKM (OK‐Junior) and DSKM (KZ2)
For receiving of online registration later than the 01/03/2019:	2.700, ‐ Euro	for DSKC (KZ2)

For DEKM the DEKM regulations apply in this matter:

For receiving of online registration up to 01/03/2019:	12.900, ‐ Euro	for DEKM
For receiving of online registration later than the 01/03/2019:	zzgl. 1.250, ‐ Euro	for DEKM

The invoice for the registration/entry fees is to be issued on the name of
(if necessary VAT-ID-No for invoices without german VAT => please fill the field “VAT-ID-No” hereunder)

the Entrant
the Driver
another address (please fill the next 4 fields)

Name or company:

ZIP Code / City:

Street:

Country:

VAT-ID-No:

The registration/entry fees are to be transferred to the account of Deutsche Motor Sport Wirtschaftsdienst GmbH (DMSW GmbH):

	Beneficiary:	DMSW GmbH
	Bank:	Deutsche Bank Frankfurt
	IBAN:	DE83 5007 0010 0094 8836 00
	BIC:	DEUTDEFF
	Reference:	#driver’s name# DKM2019
		#driver’s name# DJKM2019
		#driver’s name# DSKM2019
		#driver’s name# DSKC2019
		#driver’s name# DEKM2019

Any Entrant/Driver failing to pay the registratio/entry fees until the 1st round (entry closing date) will not be admitted to the event.
Cash payments at the event are not possible.

APPLICATION FORM