ENTRY FORM of National Team
Nation: ……………………………………………………………………………………………………
National Airsports Control of: …………………………………………………………………………
We wish to enter the following competitors who qualify under the FAI Nationality or `Residence Rules (General Section 3.7):
Class |
Function in Team |
Surname & Name |
Birth Date |
Gender |
FAI Sporting License Nº |
Pilot License Nº |
T-shirt Size |
Aircraft Manufacturer and Type |
Aircraft Registration |
Starting Number |
Banquet (not obligatory) |
Entry Fee (obligatory) |
TOTAL |
AL-2 |
Team Leader Pilot |
GIBSON Dave |
12.03.1981 |
Male |
GBRXXXXX |
YYYYYYYY |
XL |
Pipistrel Virus |
G-DAON |
1 |
45 € |
525 € |
570 € |
AL-2 |
Team Leader Assistant |
BERTOLLI Luca |
30.07.1976 |
Male |
ITAXXXXX |
YYYYYYYY |
L |
Egovoyager Voyager 203 |
I-LUCA |
32 |
45 € |
150 € |
195 € |
AL-2 |
Navigator |
WAGNER Eva |
24.05.1965 |
Female |
GERXXXXX |
YYYYYYYY |
S |
Air Creation Tanarg |
D-EAWR |
15 |
0 € |
450 € |
450 € |
AL-2 |
Guest |
EKLOF Björn |
06.09.1970 |
Male |
SWEXXXXX |
YYYYYYYY |
XL |
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45 € |
50 € |
95 € |
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TOTAL |
€ |
This amount is enclosed/will be paid by (date) ............................................................... in the form of (currency) ........................................................
Team Leader’s Contact Data:
E-mail:
………………………………………..
Phone number: …………………………………………
Signed: Position in NAC:
Print Name: Place and Date:
IMPORTANT NOTES: BANK INFO:
1. The closing date for the receipt of entry fees is 28 days before the start of the event . Beneficiary name: AEROKLUB WŁOCŁAWSKI
All fees have to be paid in full and organizer’s bank must receive payment no later than 18.07.2015 . Beneficiary address: Lotnisko Kruszyn 87-853 KRUSZYN
Late entries may not be accepted. We declare that the above information is true. Bank name: Millenium Bank
2. Please mark all payments with “EMC 2015”. Bank address: Al. Jerozolimskie 123A 02-017 WARSZAWA
3. The Entry Form of National Team must be sent via e-mail and post to the organizers no later than 18.07.2015 . IBAN: PL 94 1160 2202 0000 0000 8330 1354
4. All fees and prices according to the Bulletin No.1 . A/C No.: 94 1160 2202 0000 0000 8330 1354
Swift Code /BIC/: BIGBPLPWXXX