Application
Copyright 2007 - Jens Jansen
Driver's Full Name:
(*)
Address:
(*)
Phone:
(*)
Fax:
E-mail:
(*)
Co-Driver's Name:
Vehicle
H-Type
S-Type
Old Interceptor
541
C-V8
Interceptor
FF
S-V8
other
Mk I
Mk II
Mk III
DeLuxe
R
S
SP
other
Make:
Model:
(*)
Specifics:
(*)
Year:
Capacity (ccm):
Power (BHP):
Known history,
special features:
Organisation Fee
(includes catering during trips and dinner on Friday and Saturday, no drinks, no accomodation)
150
EUR
Car and Driver only:
0
1
2
3
4
EUR
x 50 EUR =
Co-Driver and any additional person:
(to be paid by bank transfer
and due after confirmation)
Total:
EUR
All payments to:
Joerg Huesken
Commerzbank Dresden
IBAN: DE55 8504 0000 0651 0671 00
BIC/SWIFT: COBA DE EFXXX
Jensen Meeting 2007
(*) required
Download
Application Form
as .pdf
I
mpressum
