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	ENTRY FORM FOR PARTICIPATION AS GUEST DRIVER
(Entry form for single competition of the DMSB Karting Championship 2019 in class/category mentioned below) PAY ATTENTION: FOR EACH COMPETITION REQUESTING A START AS A GUEST DRIVER, A SEPARATE ENTRY REQUEST FORM IS REQUIRED !

CHOOSE THE COMPETITION: (round of series)*

Round 1: LONATO (12-14/04/2019)
Round 2: WACKERSDORF (10-12/05/2019)
Round 3: KERPEN (12-14/07/2019)
Round 4: GENK (02-04/08/2019)
Round 5: AMPFING (04-06/10/2019)

Please note: when using this form for several Rounds successively, wait a few seconds before submitting the next form, otherwise you'll get a timeout-error (spam protection)

CHOOSE YOUR CATEGORY:*

DKM (German Karting Championship) – OK
DJKM (German Junior Karting Championship) – OK-Junior
DSKM (German Shifter Karting Championship) – KZ2
DSKC (DMSB Shifter Karting Cup) – KZ2

INFORMATION

With this application form Entrant and Driver entrust and authorize the DMSB or DMSW GmbH to submit on their behalf entries to the organizer of the competition of the above selected round of DMSB Championship 2019.
The complete entry request 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 relevant 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:*

Email‐address:*

DRIVER

Last name:*

Given name:*

Date of birth:

Licence-No.:

Grade of your int. karting licence:

C-Junior C-Restricted C-Senior B-Senior A-Senior

DRIVER’S ADDRESS

ZIP (Postal Code):

City:

Address (street+no.):

Country:

Mobile phone number:

Email‐address:*

DMSB SPONSOR CARD (if available)

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

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 entry form must arrive at the DMSB administration office before the entry closing date (general the last Sunday before the relevant competition).

ENTRY FEES:

The entry fee must be paid immediately after receiving the completed entry form by email.
The entry fee for participation with guest status includes the environmental and service charge for is 450,- Euro per competition (incl. 19% German VAT).

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):*

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

Name or company:

ZIP Code / City:

Street: