WARTELISTE - Fahreranmeldung Erzbergrodeo XIX 2013 - WARTELISTE

Vorname*

Nachname*

Geb.Datum - TT.MM.JJJJ ( Datum bitte so angeben)*

Adresse *

Postleitzahl*

Stadt*

Land*

Bitte auswählenAfghanistanAlbaniaAlgeriaAmericanSamoaAndorraAngolaAnguillaAntarcticaAntiguaandBarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosniaandHerzegovinaBotswanaBouvetIslandBrazilBritishIndianOceanTerritoryBruneiDarussalamBulgariaBurkinaFasoBurundiCambodiaCameroonCanadaCapeVerdeCaymanIslandsCentralAfricanRepublicChadChileChinaChristmasIslandCocos(Keeling)IslandsColombiaComorosCongoCongo,DemocraticRepublicoftheCookIslandsCostaRicaCôted'IvoireCroatiaCubaCyprusCzechRepublicDenmarkDjiboutiDominicaDominicanRepublicEcuadorEgyptElSalvadorEquatorialGuineaEritreaEstoniaEthiopiaFalklandIslands(Malvinas)FaroeIslandsFijiFinlandFranceFrenchGuianaFrenchPolynesiaFrenchSouthernTerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeardIslandandMcDonaldIslandsHolySee(VaticanCityState)HondurasHongKongHungaryIcelandIndiaIndonesiaIran,IslamicRepublicofIraqIrelandIsleofManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea,DemocraticPeople'sRepublicofKorea,RepublicofKuwaitKyrgyzstanLaoPeople'sDemocraticRepublicLatviaLebanonLesothoLiberiaLibyanArabJamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia,theformerYugoslavRepublicofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshallIslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia,FederatedStatesofMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlandsAntillesNewCaledoniaNewZealandNicaraguaNigerNigeriaNiueNorfolkIslandNorthernMarianaIslandsNorwayOmanPakistanPalauPalestinianTerritory,OccupiedPanamaPapuaNewGuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuertoRicoQatarRéunionRomaniaRussianFederationRwandaSaintBarthélemySaintHelenaSaintKittsandNevisSaintLuciaSaintMartin(Frenchpart)SaintPierreandMiquelonSaintVincentandtheGrenadinesSamoaSanMarinoSaoTomeandPrincipeSaudiArabiaSenegalSerbiaSeychellesSierraLeoneSingaporeSlovakiaSloveniaSolomonIslandsSomaliaSouthAfricaSouthGeorgiaandtheSouthSandwichIslandsSpainSriLankaSudanSurinameSvalbardandJanMayenSwazilandSwedenSwitzerlandSyrianArabRepublicTaiwan,ProvinceofChinaTajikistanTanzania,UnitedRepublicofThailandTimor-LesteTogoTokelauTongaTrinidadandTobagoTunisiaTurkeyTurkmenistanTurksandCaicosIslandsTuvaluUgandaUkraineUnitedArabEmiratesUnitedKingdomUnitedKingdomUnitedStatesUnitedStatesMinorOutlyingIslandsUruguayUzbekistanVanuatuVenezuelaVietNamVirginIslands,BritishVirginIslands,U.S.WallisandFutunaWesternSaharaYemenZambiaZimbabweÅlandIslands

Nationalität*

Bitte auswählenAfghanistanAlbaniaAlgeriaAmericanSamoaAndorraAngolaAnguillaAntarcticaAntiguaandBarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosniaandHerzegovinaBotswanaBouvetIslandBrazilBritishIndianOceanTerritoryBruneiDarussalamBulgariaBurkinaFasoBurundiCambodiaCameroonCanadaCapeVerdeCaymanIslandsCentralAfricanRepublicChadChileChinaChristmasIslandCocos(Keeling)IslandsColombiaComorosCongoCongo,DemocraticRepublicoftheCookIslandsCostaRicaCôted'IvoireCroatiaCubaCyprusCzechRepublicDenmarkDjiboutiDominicaDominicanRepublicEcuadorEgyptElSalvadorEquatorialGuineaEritreaEstoniaEthiopiaFalklandIslands(Malvinas)FaroeIslandsFijiFinlandFranceFrenchGuianaFrenchPolynesiaFrenchSouthernTerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeardIslandandMcDonaldIslandsHolySee(VaticanCityState)HondurasHongKongHungaryIcelandIndiaIndonesiaIran,IslamicRepublicofIraqIrelandIsleofManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea,DemocraticPeople'sRepublicofKorea,RepublicofKuwaitKyrgyzstanLaoPeople'sDemocraticRepublicLatviaLebanonLesothoLiberiaLibyanArabJamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia,theformerYugoslavRepublicofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshallIslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia,FederatedStatesofMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlandsAntillesNewCaledoniaNewZealandNicaraguaNigerNigeriaNiueNorfolkIslandNorthernMarianaIslandsNorwayOmanPakistanPalauPalestinianTerritory,OccupiedPanamaPapuaNewGuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuertoRicoQatarRéunionRomaniaRussianFederationRwandaSaintBarthélemySaintHelenaSaintKittsandNevisSaintLuciaSaintMartin(Frenchpart)SaintPierreandMiquelonSaintVincentandtheGrenadinesSamoaSanMarinoSaoTomeandPrincipeSaudiArabiaSenegalSerbiaSeychellesSierraLeoneSingaporeSlovakiaSloveniaSolomonIslandsSomaliaSouthAfricaSouthGeorgiaandtheSouthSandwichIslandsSpainSriLankaSudanSurinameSvalbardandJanMayenSwazilandSwedenSwitzerlandSyrianArabRepublicTaiwan,ProvinceofChinaTajikistanTanzania,UnitedRepublicofThailandTimor-LesteTogoTokelauTongaTrinidadandTobagoTunisiaTurkeyTurkmenistanTurksandCaicosIslandsTuvaluUgandaUkraineUnitedArabEmiratesUnitedKingdomUnitedKingdomUnitedStatesUnitedStatesMinorOutlyingIslandsUruguayUzbekistanVanuatuVenezuelaVietNamVirginIslands,BritishVirginIslands,U.S.WallisandFutunaWesternSaharaYemenZambiaZimbabweÅlandIslands

Telefon*

e-mail*

Führerschein Nr.*

Motorradmarke (KTM, SUZUKI,...)*

Motorradtype (525 EXC, YZ 250,...)*

Ich melde mich an für:

Iron Road Prolog Only: Euro 112,-- (inkl. 20% Ust.)Iron Road Prolog & Red Bull Hare Scramble: Euro 189,-- (inkl. 20% Ust.)

Rocket Ride: Euro 49,-- (inkl. 20% Ust.)

Ich starte in der Klasse*

Competition (Cross + Enduro) ClassMore Cylinder (Mehrzylinder)Ladies CupQuad / ATV

Anzahl der Begleitpersonen*

Team Name (max. 18 zeichen)

Bei Unfall folgende Personen benachrichtigen : Vorname - Nachname*

Telefon des Notfallkontaktes*

Fahrer Bild / rider picture - Upload (max. 80 kb)

Nachricht an Erzbergrodeo-Administration

Freier Kommentar / Platzierungsprognose erwünscht:

AGB*

Ich habe die AGB gelesen und akzeptiert.

 

AGB

 

Die Übermittlung der Daten kann einige Minuten dauern.

 

Erzbergrodeo XIX