Registration form

Pilot Name* : Surname* : Address* : Postal code* : City* : Country* : Tel number* : Mobile number* :
Fax number :
Email* :

Copilot 1
Copilot 2
Copilot 3
Copilot 4

Car info Car* : License plate number* : Number driving licence* : Blood type :
I register my Subaru for the Meguiar’s Show & Shine? : YesNo

Subaruclub info Subaru Club Member?: YesNo
Name Club:
Website club:

F1 Pitbox F1 Pitbox (150 euro)*: Yes No

Discharge document   Download Nederlandstalige versie
  Download English version
  Download version française

Disclaimer Disclaimer:

Hereby declares to participate voluntarily at the Subaru Trackday on Sunday the 18th of March 2012 on the circuit of Spa-Francorchamps in Belgium. The undersigned knows that participating contains certain risks and explicitly declares to know and accept these risks. The undersigned acknowledges to have been informed of the rules during this trackday and undertakes to respect those rules without reservation.
The undersigned notes that the organizer (Cyr Provost), all relatives, the insurance companies, the owner and/or manager of the circuit of Spa-Francorchamps, Subaru Belgium, RareRims (main sponsor of Subaru Trackday), other participants, authorised volunteers, sponsors, affiliated enterprises cannot be held liable for any accidents which would occur in connection with the fore mentioned trackday nor for any damages resulting thereof. In case of death, this discharge form is also valid against the claims of claimants, heirs, surviving dependants and insurers of undersigned. It is also mandatory for pilot and co-pilot to wear a helmet during all sessions.
The undersigned hereby explicitly waives the right to file a claim in order to obtain indemnification against the organizer (Cyr Provost), all relatives, the insurance companies, the owner and/or manager of the circuit of Spa-Francorchamps, Subaru Belgium, other participants, authorised volunteers, sponsors, affiliated enterprises of the Subaru Trackday on the 18th of March 2012 on the circuit of Spa- Francorchamps in Belgium, for any damage whatsoever, caused in the framework of the fore mentioned happening, to him/herself and to his/her goods.

DAY OF NON-COMPETITION. NO REGISTERED TIMING OF ANY KIND WILL BE ALLOWED

With this registration, I accept the terms and conditions* : Yes

Several Email newsletters will be sent in preparation of the Subaru Trackday. So check your mailbox for the Subaru Trackday newsletter. If you do not receive these newsletters, please contact the organisation.

* Required fields

Partners

VJB Motors
Prins-Bisschopssingel 4074
3500 Hasselt

Garage Germaine nv
Beukheuvel 48
2500 Koningshooikt

Ets Dany Hoyas
Rue de Baudour 34
7011 Ghlin

@subarutrackday

Entire Day	235 euro	Yes	No
Open Pitlane AM	150 euro	Yes	No
Open Pitlane PM	175 euro	Yes	No
Warm Up Session AM	€ 80/session	Yes	No
Warm Up Session PM	€ 80/session	Yes	No
Co-Pilots	10 euro/pp