Registration Form  Jubilee Weekend 7-8-9-sept.
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Membership Number

 

When unknown fill 3x zero!

 

Full Name

 

Address.*

 

Postal code + Residence

 

Emailadres

 

(Mob.)Phonenumber

 

 

 

 

 

Model Jeep/Type

 

Registration Number

 

Driver license number

 

Insurance policy number

 

Insurance Company

 

 

 

 

Number of Adults

 

Number Child. max 15 yr

 

 

Preference Trial Class

 

Blue:

Red:

Black:

 

 

 

 

Registration:
The undersigned will attend the Jubilee weekend from
Friday 7th to Sunday 9th September 2012:

(Registration form for 1 Jeep! So 2 Jeeps, 2 forms, etc.)

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Event participation full weekend per jeep
Including driver, and Saturday night BBQ

 

à € 100,00

€ 

 

 

 

 

Additional adult, including Saturday night BBQ
Child (max 16 years), incl. Saturday night BBQ

 x
 x

€   40,00
€   10,00

€ 
€ 

 

 

 

 

Additional catering:

 

 

 

Adults

 

 

 

Breakfast € 8.00 per day, per person
Soup / Pasta buffet Friday night € 15.50 p.p.

 x
 x

€   8,00
€ 15,50

€ 
€ 

 

 

 

 

Children, max 15 years

 

 

 

Breakfast € 4.00 per day p.p.
Soup / Pasta buffet Friday night € 8.00 p.p.

 x
 x

€   4,00
€   8,00

€ 
€ 

 

 

 

________

 

 

Total

€ 

Please pay the amount due into the following bank account number
Iban: NL22 RABO 0321 6628 14 BIC: RABONL2U
with reference to Jubilee 2012, your Membership number, and your name.

Upon receipt of the amount due we will send you a confirmation and the Regulations.
This confirmation letter is your entry ticket to the event grounds; you will be required to show it at the entrance.

 

 

 

 

 

 

 

C

 

Date:   

 

   Give approval for above agreement.