Piešťanské Zlaté stuhy 2019

Electronic Application – Free Driving

VEHICLE:

Manufacturer (You can't leave this empty.)

Type, Makel (You can't leave this empty.)

Production Year (You can't leave this empty.)

Number of cylinders / volume (cm3) (You can't leave this empty.)

Additional facts about the vehicle,history

Please attach one color photograph

DRIVER:

Name (You can't leave this empty.)

Surname (You can't leave this empty.)

Date of Birth (You can't leave this empty.)

Adress (You can't leave this empty.)

E-mail (You can't leave this empty.)

Telephone, Cell phone (You can't leave this empty.)

FRONT SEAT PASSENGER:

Name

Surname

STARTING FEE:

Driving at the airport / 43€
I agree

Participant’s package PZS / 460€
yesno

Programme at Thermia Palace on June 14, 2014 / 2 persons
Advertising partner of the event

I declare and agree that I will not require the organizer to redeem any damages caused on the vehicle as well
as other possible damages resulting from this competition, including possible injuries of the driver and
passengers. I participate in the competition on my own responsibility, and I will obey the organizers’
instructions.

I agree with the terms