Dutch Balloon Trophy 2014
Entry form for the participation in the
Country :
Dutch Balloon Trophy 2014
Dutch and Belgium Championships
and
Pre-Woman’s European Hot Air Ballooning
Championship 2014
at
Wezuperbrug (NL) from May 28th – June 1th 2014
Participant
Fill in your identity
information.
(in CAPITALS please)
Name + First name
Home adress
E-mail
Zip + City
Date of Birth
Telephone & Mobile
Tel.
Mob.
License
Fill in your license
information.
Pilots license
(in CAPITALS please)
FAI Sporting License
Date issued
Number
Radio certificate
Balloon
Fill in the information Registration / call sign
of your balloon.
Manufacturer
in CAPITALS please)
Type / Size
Name:
Build in (year)
Hours flown
Certificate of registration
Certificate of Airworthiness
Valid till
Publicity on balloon/Colors
Insurance
Fill in the information Insurance Company
of your insurance.
Policy number
in CAPITALS please)
Valid till
Third party limit
Date:
Signature:
Remarks:
Valid till
Dutch Balloon Trophy 2014
Entry form for the participation in the
Country :
Dutch Balloon Trophy 2014
Dutch and Belgium Championships
and
Pre-Woman’s European Hot Air Ballooning
Championship 2014
at
Wezuperbrug (NL) from May 28th – June 1th 2014
Participant
Fill in your identity
information.
(in CAPITALS please)
Name + First name
Home adress
E-mail
Zip + City
Date of Birth
Telephone & Mobile
Tel.
Mob.
I order:
Meals
Maps
Number
Number
Description
Price/set
Total
Meals
€ 45,00
€
Diner / Buffet
€ 17,50
€
Description
Price/set
Total
Extra Maps
€ 25,00
€
Sent maps to your adress
€ 5,00
€
Total amount:
Description
Price
Entry fee
€
Meals
€
Maps
€
Sending maps
€
Paid
Total €
Account information:
Account number 3822.45.709
(Rabobank)
IBAN nl 17 RABO 0382 2457 09
Atn. Dutch Balloon Competition Club.
If you have any questions or send entry forms by e-mail, please contact us on:
[email protected] or [email protected]
Forms can also be send to:
Dutch Balloon Competition Club
De Gheynstraat 10
6717 RG EDE
Bert Stuiver,
Dilweg 1,
7873 BN Odoorn.
Tel: 0031-591-513467 mob. 0031-646204401