Please fill in all fields

After completing all fields, please click on 'Send' to confirm your registration

After sending you will see the confirmation page

 

  Driver  Co-driver
Name + given name
Street + number
Postal code + city
Phone
Mobile phone
e-mail    
Gender M M F
Date of birth
Nationality B   NL   D  DK GB    NL   D  DK  GB
     
     
Voertuig / Véhicule    
Make  
Type  
Color       
Cylinder capacity  
Year of construction   
License plate  
The entry fee is 160,- EUR - (plus 15,- EUR for a "one-day licence" for driver and co-driver).
 A team will only be entered onto the entry list, after receipt of the payment.

Payment :
 - Account holder: Autostal Hemicuda vzw
 - Account number: BE60 0682 1050 4070
 - BIC GKCCBEBB
 - IBAN BE60 0682 1050 4070
- Reference: RdV 18
- Name of driver + Name of co-driver