BLANCPAIN GT SERIES ASIA SEASON ENTRY FORM 2018 Please fill the form below (one per car) and return it signed with a proof of payment and copies of the Team and Drivers Licences (Front and Back) to : BENJAMIN FRANASSOVICI - Blancpain GT Series Asia Manager / By Email :
[email protected] COMPETITOR / TEAM TEAM NAME NATIONALITY TEAM MANAGER NAME ADDRESS POSTCODE CITY COUNTRY TELEPHONE MOBILE EMAIL ENTRANT LICENCE N°/ issued by/AS N ENTRANT LICENCE GRADE ENTRANT LICENCE NAME VAT NUMBER WEBSITE CAR / MAKE/ MODEL TRANSPONDER NO ° PREFERRED RACE NUMBER GIVEN RACE NUMBER (TO BE FILLED BY SRO) (GIVE 3 NUMBERS) / / SELECT BELOW THE SERIES AND CATEGORY YOU WISH TO ENTER CATEGORY GT3 ENTRY FEES PRO/AM AM CUP GT3 GT4/GTC Before 31/12/2017 SILVER CUP $ 40,000 $ 34,000 *Early Bird CATEGORY GT4 After 31/12/2017 $ 43,000 $ 36,000 AM After 31/01/2018 $ 46,000 $ 38,000 CATEGORY GTC Race By Race $ 8,000 $ 6,500 PRO/AM *Subject to Capacity DRIVER 1 DRIVER 2 FULL NAME FULL NAME NATIONALITY NATIONALITY (AS PER PASSPORT) (AS PER PASSPORT) DATE OF BIRTH/AGE* DATE OF BIRTH/AGE LICENCE N° & TYPE LICENCE N° & TYPE LICENCE NATIONALITY LICENCE NATIONALITY ASN GRADE ASN GRADE DRIVER FIA GRADING DRIVER FIA GRADING ADDRESS ADDRESS PHONE PHONE EMAIL EMAIL *IF DRIVER IS UNDER 18 A PARENT OR GUARDIAN MUST COUNTERSIGN PAGE 2 *IF DRIVER IS UNDER 18 A PARENT OR GUARDIAN MUST COUNTERSIGN PAGE 2 SRO MOTORSPORTS ASIA 26/F Wyndham Place, 44 Wyndham St. Central Hong Kong BLANCPAIN GT SERIES ASIA SEASON ENTRY FORM 2018 2018 CALENDAR MALAYSIA | 14 - 15 APRIL 2018 Sepang International Circuit THAILAND | 12 - 13 MAY 2018 Chang International Circuit JAPAN | 30 JUNE – 01 JULY 2018 Suzuka International Circuit JAPAN | 21 - 22 JULY 2018 Fuji Speedway International Circuit CHINA | 22 - 23 SEPTEMBER 2018 Shanghai International Circuit CHINA | 13 - 14 OCTOBER 2018 TBA Track DECLARATION I declare that I have been given the opportunity to read the General Regulations of the AAM and, if any, the Supplementary Regulations and commercial undertakings for this event and agree to be bound by them.