ENTRY FORM

INDIVIDUAL ENTRY FORM

TEAM

CONTACT PERSON:

First Name:		Surname:
Phone:		e-mail:

On this email you will receive confirmation of completing the form.

DRIVERS:

#	1-ST DRIVER	2-ND DRIVER
Family Name
First Name
Pseudonym*
Date of birth
Nationality
Passport No.
Address for corespondence
Contact phone
E-mail
Driving Licence No.
Country of Issue

In case of emergency please inform:

Name

Phone

DETAILS OF THE VEHICLE

Make		Registration No.
Model		Chassis No.
Year of manifacture		Cubic Capacity
Group/Class		Turbo
FIA Homolgation No.		Predominant Colour
Country of Registration		Technical Passport No. (if it refers)

PAYMENT CONFIRMATION

ENTRY FEES

Termin 1: do: 10/10/2019, 23h:59 - with organiser optional advertising
660 EUR - S1,S2535 EUR - UTV/SSV

INVOICE INFORMATION

Company Name		VAT Number:		Country
Street		Zip code		City

BANK INFORMATION

PAYMENTS IN EURO (EUR):

Rallye Breslau International Association

Bank: Stadt- und Kreissparkasse Leipzig

Leipzig, Germany

IBAN: DE61 86055592 1090047572

SWIFT: WELADE8L

In title of payment must be mentioned Full name of Competitor
and Drivers!

The competitor must bear the cost of bank transfers.

I am NOT registered to Inside PZM, - My files are not on the site. I will send a set of documents to the Organizer e-mail: info@baja-europe.com

I declare to have no doubts about the risks and dangers of motor sport events and for such contingencies and any other results from my participation in this event, I accept full and absolute responsibility and renounce to ask any posterior responsibility to the Organizer.

I also declare to have full knowledge of the rules and regulations issued by the FIA and the PZM sporting regulations covering and governing automobile sport in all aspects, as well as anti-doping rules on the prohibition of the use of the prohibited substances and methods, and I guarantee to respect all such rules and regulations without exception.

I declare, that all data entered in above entry form (such as personal data, numbers of documents) are correct and valid. By my signature I declare that all the information contained on the entry form is correct and that I acknowledge and agree in full to the terms and conditions of the above indemnity and that I accept all the terms and conditions relating to my participation in this event.

Information clause on the processing of personal data
Due to the necessity of processing personal data to inform you that:
1. The controller of the personal data (CPD), provided in the application form, is the Organiser of the event Automobilklub Wielkopolski, ul.Towarowa 35/37 61-896 Poznań and Rallye Breslau International Association.
2. The provision of data is necessary to accept the entry form and participation in the aforementioned competition/event and their frailer will prevent it.
3. Personal data will be processed for the following purposes:
a. participation in the competition/event, including classification in the results of the competition/event and then in the annual classification of a given series;
b. an assessment of the ability to participate in a given competition, based on a medical certificate;
c. confirmation of club membership;
d. promoting competition/event by publication of photos, e.g. of participation in competitions/events, prize giving ceremony, etc;
e. imposing disciplinary action;
4. The legal basis for the processing of a personal data is article 6(1)(b) of the GDPR, i.e. processing necessary to perform the contract (which is the entry form) and take action at the request of the person concern, related to accepting of the entry form and the possibility of participating in the motor sport, as well as article 6(1)(f) of the GDPR, i.e. processing is necessary for the purposes of the legitimate interests pursued by the controller or by a third party, such as promotion of the competition/event.
5. The recipients of personal data will be e.g:
a. International Sports Federations, when appropriate;
b. National Sports Federations, in the event of a competition/event in their jurisdiction;
c. media, users of websites, in connection with the publication of results, press releases, photos from competitions/events;
d. insurance companies, when applicable;
e. postal and courier companies, ensuring the exchange of correspondence.
6. The personal data will be stored in the case of competition/event documents for a period of 2 years. In the case of annual results and classifications – without any time limit. In the event of disciplinary proceedings in accordance with the procedure governing such proceedings.
7. The rights of the data subject are:
a. to request access to personal data, to rectify the data and to receive a copy of this data, as well as to receive full information about the processing of this data;
b. to request the deletion of personal data or to restrict the processing of this data to its storage, as well as raising objections to their processing;
c. to receive the provided personal data in the form of a computer file in a commonly used format or to send this file to another data controller;
d. to lodge a complaint with the President of the Office for Personal Data Protection against the processing of personal data by the CPD.
8. All requests, questions and demands related to this processing should be addressed to the Organiser at the following email address: info@rallye-breslau.com