Qatar Cross Country - Moto Entry Form

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ENTRY FORM - MOTO

ENTRANT*

Entrant Name

Competition Licence

Issuing FMN

E-maila valid email

AddressThis is the mailing address

P.O.Box

Country

Phone(Business)

Mobile

Fax

Tel No (Qatar)

Please enter the phone and fax numbers in international format (e.g +000 xxxx xxxx)

RIDER*

First Name

Family Name

Date Of Birth

Passport No.

Issued Date

Expiry Date

FIM Licence No

Issuing FMN

Int' Driving Licence No

E-maila valid email

AddressThis is the mailing address

P.O. Box

Phone No (Private)

Fax

Mobile No

Next In Kin

Relationship

Telephone No

Please enter the phone and fax numbers in international format (e.g +000 xxxx xxxx)

MOTORCYCLE / QUAD DETAILS *

Owner Name

Make

Model

Color

Engine CC

Registration No.

Chassis No

Engine No

DOCUMENTS UPLOADS *

Team Licenseupload

Upload

2017 FIM World championship Cross-Country Rallies licence (with starting permission) or 2017 FIM World championship Cross-Country Rally One event licenceupload

Upload

ID Card / Passport with Residence Visaupload

Upload

Driving licenceupload

Upload

Motorcycle Registration Papersupload

Upload

Written authorization to use the motorcycle if the competitor is not the owner.upload

Upload

Medical form completedupload

Upload

ENTRY FEES *

Type Of Entry

Until 15 March 2018

Until 05 April 2018

Overseas Entries

US $ 3,790

US $ 4,610

Gulf Entries

QAR 8,600

QAR 10,300

Tracking System Rental - €175.00

All entry fees must be paid by bank transfer, to the following bank

account: Qatar Motor & Motorcycle Federation (QMMF)

Bank name: Qatar International Islamic Bank Branch: Main Branch,

Grand Hamad Avenue, P.O.Box 664, Doha, Qatar.

Account Number: 1111-410066-001 Swift Code: QIIBQAQA

Please attach your Payment Proof of the Entry Fee and Tracking system rental fee

Payment Proof Attachment - Entries will be countable as valid entry only if the payment proof is attachedupload

Upload

ACKNOWLEDGEMENT AND AGREEMENT *

I Agree

As per Art 60.5 of the FIM Sporting Code, the participant exonerates the FIM, the FMN, the organizers and the officials, their employees and officers and agents from any and all liability for any loss, damage or injury which he may incur in the course of an official meeting or the training thereof, except under the provisions of Article 110.3 thereinafter.

Furthermore, the participant undertakes to indemnify and hold harmless the FIM, the FMN, the organizers and officials, employees, officers and agents, from and against any and all liability to third parties for any loss, damage or injury for which he is jointly and severally liable.