MOTOGIRO D’ITALIA 2021 – 30^ HISTORICAL RECALLING PRE ENTRY FORM - FROM 23 TO 29 MAY2021 PRE-REGISTRATION FORM WITHOUT HOTEL PACKAGE HERITAGE CATEGORY , HISTORICAL COMMEMORATIVE CATEGORY , VINTAGE CATEGORY , CLASSIC CATEGORY ,MOTOGIRO D’ITALIA CATEGORY ,TOURIST CATEGORY (CROSS YOUR CHOICE ) PARTICIPANT SCHEDULE RIDER PASSENGER ESCORT ASSISTANT/MECHANIC (WITH A HIS/HER PROPER VAN OR CAR) SURNAME AND NAME(S) _________________________________________________________________ Place and date of birth _____________________________________________________________________ Town Address Telephone: Home _______________ Work _______________ ______________________ ______________________________ Mob. _______________ Post code_______ _______________n.er ______ ______ e-mail: ____________________________@__________________ (It ‘s important to give us this detail to easily inform you all further information) Licence n.er__________________ Member of Motorcycle club ______________________________________ Request for Terni Club Membership card □ town________________________________________________________ Driving Licence n. Issued in (town) On (date) Expiry date Vehicle details Model ___________________________________ (Trademark) ____________________________________ Swept volume___________________________ Motorcycle Sidecar outfit Scooter Manufactured year Second Vehicle details Model ___________________________________ (Trademark) ____________________________________ Swept volume___________________________ Motorcycle Sidecar outfit Scooter Manufactured year I enclose the receipt for the payment of € 500.00 as the pre-registration fee. Furthermore, pursuant to Italian Legislative Decree 196/03, I authorize you to use the data contained herein. I declare that I have read and accepted the contents of the attached excerpt of the regulation The event is open to all types of current and vintage scooters, sidecars and motorcycles according to the years and the displacements of the various categories specified in the excerpt of the regulation. Drivers: requirements required by the Highway Code, F.M.I. and for the vintage motorcycles of the Italian drivers the historical register F.M.I. o A.S.I. Seven days, six stages on the most scenic and beautiful roads of our Italy. The cost for registering riders, passengers and assistants / mechanics, excluding the hotel package and all extras, is Euro 690.00 (including the pre-registration fee of Euro 500.00). NB: Payment can be made: - online, by credit card, on the website www.motogiroitalia.it; - by bank transfer, IBAN IT 78 N. 010 0514 4000 0000 0006 905 - SWIFT / BIC BNLIITRR - CC. 006905 ABI 01005 - CAB 14400- BNL Branch of Terni, in the name of: Moto Club Terni L. Liberati P. Pileri, Via Bertani, 4 - 05100 - Terni; - by sending a copy of the receipt to: Moto Club Terni L. Liberati P. Pileri , Via Bertani, 4 - 05100 - Terni; With Pay Pal to the e-mail address: [email protected] ;. For electronic payments there is an additional charge for management / administrative costs, registration will be automatically validated only after receipt of payment. For contacts: Motogiro d'Italia Secretariat: from Monday to Friday and from 11.00 to 13.00 and from 17.30 to 19.00 - Mobile +39 335 370928 fixed + 39 0744 404380, on Monday, Wednesday, Thursday, from 17.30 to 19.30., Tuesday, Friday after 21.15 to 22.30. ; e-mail: - [email protected]; - [email protected] ; it is essential to send some photos of your motorcycle MOTOGIRO D'ITALIA BOOKING FORM 2021 SURNAME…………………………………..………………………NAME(S)………………………………..……………… DOMICILED IN………………………………………………………………………………… ADDRESS……..…………………………..……………………………………………………. TELEPHONE N.…………........................................................................................................... RANK: RIDER TOURIST ESCORT PASSENGER ASSISTANT/MECHANIC REGISTRATION WITHOUT HOTEL RESERVATION INCLUDES: The assistance continues throughout the event by over fifty highly professional people, part of the STAFF (one of the most qualified organizations ever). • Mechanical assistance for small repairs (punctures, checks on the electrical system, ropes and sheaths, small welds) for work of different entities, the price of the intervention will be agreed directly with the mechanics. Spare parts and consumables must be immediately paid separately to the service provider (following two mobile workshops with four highly specialized mechanics); • Transport of rider and motorbike in case of failure of the same; (Following two minibuses with eight seats available for each vehicle; N.B. Only for participants who Use a photocopyUse the offor booking form multiple - will follow the route of the event in detail); ecipant • Medical assistance; during the event, (Following, eight doctors and paramedics on motorcycles in cars and an ambulance, the same will be distributed along the entire caravan in order to reach and immediately rescue the participant in trouble. (Any transport from the emergency room to the stage locations or upon arrival will be the responsibility of the participant, as they can be reimbursed by their Federation to which they belong). The indicated fees the toinare form each part for • Tracing with personalized arrows "Motogiro d’Italia" of the entire route of the event; • Road book of the whole itinerary; • Relays along the route at the checkpoints; • Bib with your number; • Three oval stickers to be placed on the number plates with the assigned number; • Embroidered polo shirt and embroidered cap; • Gadgets; • Awards and / or memories; • Departure and Arrival from a dedicated exhibition "Village" set up for the occasion; • Welcome buffet, at lunchtime on Sunday 23 May 2021, the day dedicated to preliminary operations and the subsequent mandatory Briefing with all participants and the organization; • Food tastings, in some of the checkpoints during all stages; • Event insurance as per F.M.I. and legal dictates; ACCESSORY SERVICES: - For non-members of the F.M.I. compulsory membership card for insurance reasons: card € 60.00; - Personalized photographic service (The price will be agreed directly with the photographer) - TEAM REGISTRATION: € 50.00, to be paid at the time of registration of the team during the preliminary operations. NB: the minimum deposit to be paid, as pre-registration, is € 500.00 otherwise reservations will not be taken into consideration. The pre-registration amount is a down payment and is an integral part of the total cost of registration. RIDER, PASSENGER, ACCOMPANIMENT, ASSISTANT / MECHANIC. SIGNING UPACCESSORY SERVICES: (add directly what you need and make the total bill yourself). Confirmation of attendance at the gala dinner is mandatory, otherwise the dinner will not be booked, even if included in the registration. Gala Dinner Reservation (Included in Registration), I will be present at the Gala Dinner on 23 May 2021 yes no Mandatory for insurance reasons, for participation in the event, the membership card of a FMI motorcycle club, if you do not have one, will be issued directly by the Moto Club Terni Libero Liberati - Paolo Pileri at an additional cost of € 60.00 .. € _______________ Second bike with registration and transport at the expense of the organization (maximum 10 bikes in total) € 100.00 € _______________ GENERAL TOTAL € ________________ LESS DISCOUNT / PRE-REGISTRATION € ________________ TO BE PAID IN BALANCE € ________________ NOTE __________________________________________________________________________ __________________________________________________________________________ ________________________________________________ My clothing size is: S M L XL XXL XXXL XXXXL I am attaching a photocopy of my identity document (in order to streamline the procedure for accessing the Hotels). I am attaching 2 passport-sized photos of mine (mandatory for all those who have not sent it in recent years) and three photos of my motorcycle. N B: The photos and the copy of the document must be sent together with the pre- registration. RESPONSIBILITY: by signing the registration form and the booking form, the participant declares to have read and accepted the "excerpt and the general regulation" of the Motogiro d'Italia 2021 event, undertaking to scrupulously comply with the requirements contained therein. the same also declares to relieve, as he raises, the Moto Club Terni L Liberati - P. Pileri, organizer of the event and all, without exception, the personnel assigned from any and all liability and damage and / or inconvenience that may arise or derive to third parties or to third party things, as a result of his participation in the event, a priori renouncing any recourse and any recourse to authorities not considered by the current regulations of the F.M.I. Date_________________ Signature___________________________________________________________ PAYMENT BY MEANS: CREDIT CARD BANK TRANSFER IBAN account code IT 78 N010 0514 4000 0000 0006 905 - SWIFT / BIC BNLIITRR –CC. 006905 ABI 01005 - CAB 14400- BNL Branch of Terni, in the name of: Moto Club Terni L. Liberati P. Pileri PAY PAL to the e-mail address: [email protected]; CASH MONEY ORDER CHECK n ° ______________________________ BANK_____________________________________________ ADDRESS TO: Moto Club Terni L. Liberati - P. Pileri, Via Bertani, 4 - 05100 Terni. FOR INFORMATION : Motogiro d'Italia Secretariat: from Monday to Friday and from 11.00 to 13.00 and from 17.30 to 19.00 - Mobile +39 335 370928 fixed + 39 0744 404380, on Monday, Wednesday, Thursday, from 17.30 to