Gouveia . Portugal . 29-30 April 2017

Round 1 – European Enduro Championship

To participate in the Enduro GP of Portugal – 2017 FIM-Europe European Enduro Championship, do the ‘DOWNLOAD’ of the Entry Form and after duly completed and signed send it by email: WECPORTUGAL@gmail.com.
However, you can fill out the form below, download, print, sign and then send via email: WECPORTUGAL@gmail.com

Discipline

Classe / Class (required)

Primeiro Nome / First name (required)

Ultimo Nome / Last name (required)

Licença / Licence

Federação / FMN (required)

Equipa / Team (required)

País / Country (required)

Nacionalidade / Nationality

Morada / Address (required)

Código Postal / Postal Code

Cidade / City

Data de Nascimento / Date of birth

Licença condução / Drive licence

Telefone Nº / Mobile Nº

Email / Email

Moto / Moto (required)

Moto Modelo / Moto Type (required)

Capacity (cm3) (required)

Matricula / Registration N°

Bore (required)

Stroke (required)

mm Stroke (required)

Quadro Nº / Frame N°

Seguradora / Insurance Company

Apólice Nº / Insurance Company Nº

Number Plate

Truck

Motor Home

Private Car

Recibo Pagamento / Payment receipt