Receipt Stamp: Class: Start Number: Cliënt Number: GT4 European Series Team Information Please send this form to: GT4 European Series T.A.V. Max Braams Glashaven 49 3011 XG Rotterdam The Netherlands Email: info@gt4series.com Fax: +31 (0) 10 412 99 89 TEAM Team Name: (Published on the Entry List) Team Manager: Street: Phone Office No.: Postal Code: Phone Mobile No.: City: Fax No.: Country: E-mail Address: VAT No: Remarks: Twitter: Facebook: ENTRANT / COMPETITOR Note: If you don t have a team entrant license, the first driver will be assigned as entrant Name Entrant: Name of Entrant: (Holder of License) ASN License No.: ASN: (Name/Country) TEAM-MANAGER INFORMATION (during event) Name: Phone Mobile No.: E-mail Address: Page 1 of 11
Driver 1 Information AM / AM is for: Silver / Bronze Silver / Silver Bronze / Bronze Silver Solo Bronze Solo PRO / AM is for: Platinum / Bronze Gold / Silver Gold / Bronze We point out that regulations (Art. 13.3. of Sporting Regulations) allow GT-future GmbH to classify each entered driver to final grade. Therefore it is required to send a copy of the ASN Licence for all the drivers entered as well as their records of results and career overview at the latest 15 days prior to the beginning of the first event in which they take part to: info@gt4series.com DRIVER 1 (entrant*) First Name: Address: Last Name: Postal Code: Date of Birth: City: Nationality Passport: Country: E-mail: Country License / ASN: Mobile: Name ASN** SOCIAL MEDIA Twitter: Website: Facebook: Instagram: LinkedIn: Youtube: * If you don t have a team entrant license please note that the first driver will be assigned as entrant ** Name ASN e.g. DMSB, KNAF, MSA, FFSA, DASK, RACB, FFSA, CSAI The entry must be signed by the Entrant/Competitor and all Drivers on the last page of this entry form. It is mandatory to attach to the original entry form, a copy of the driver license and a copy of passport of each driver, the entrant license and entrant holder. Copies of the driver licenses and passports can also be send by email (info@gt4series.com) in JPG/PDF format in full color. Page 2 of 11
Driver 2 Information AM / AM is for: Silver / Bronze Silver / Silver Bronze / Bronze Silver Solo Bronze Solo PRO / AM is for: Platinum / Bronze Gold / Silver Gold / Bronze We point out that regulations (Art. 13.3. of Sporting Regulations) allow GT-future GmbH to classify each entered driver to final grade. Therefore it is required to send a copy of the ASN Licence for all the drivers entered as well as their records of results and career overview at the latest 15 days prior to the beginning of the first event in which they take part to: info@gt4series.com DRIVER 2 First Name: Address: Last Name: Postal Code: Date of Birth: City: Nationality Passport: Country: E-mail: Country License / ASN: Mobile: Name ASN** SOCIAL MEDIA Twitter: Website: Facebook: Instagram: LinkedIn: Youtube: * If you don t have a team entrant license please note that the first driver will be assigned as entrant ** Name ASN e.g. DMSB, KNAF, MSA, FFSA, DASK, RACB, FFSA, CSAI The entry must be signed by the Entrant/Competitor and all Drivers on the last page of this entry form. It is mandatory to attach to the original entry form, a copy of the driver license and a copy of passport of each driver, the entrant license and entrant holder. Copies of the driver licenses and passports can also be send by email (info@gt4series.com) in JPG/PDF format in full color. Page 3 of 11
Car Information CAR DETAILS Make/Brand: Type: Year of manufacture: Transponder No.:* Chassis-No.: Homologation No.: Requested Start No.: 2 nd Requested Start No.: (If the first number is occupied) * Transponder: We only accept Mylaps/AMB transponders. A transponder is obligated for all classes. If your car is not equipped with an transponder then rental at the circuit is possible. HANKOOK TIRES Hankook will be the single tyre supplier for the GT4 European Series 2015. All participating teams are obligated to run the entire event (free practice, qualifying and races) on Hankook Tyres which are delivered by Hankook on track. Ordering information will be published separately. RADIO COMMUNICATION To get approval to use your radio communication, we have to collect information and forward it to the authorities. For the registration of your frequency are possibly costs involved. GT-Future GmbH will re-invoice these costs to the team. Brand: Model Transmitting Frequency (Mhz) Receiving Frequency (Mhz) ERP (Watts) Type of Equipment Page 4 of 11
Events in 2015 The Calendar Please find below our Calendar for the 2015 GT4 European Series season. Please mark the event in which you would like to participate in. In case of all events, select all the events. Track Event Date Event Type 1 Nogaro Blancpain Sprint Series 03 05 / April / 2015 3 Day Event 2 Circuit Park Zandvoort Pinksterraces 22 24 / May / 2015 3 Day Event 3 Redbull Ring ADAC GT Masters 05 07 / June / 2015 3 Day Event 4 Spa Francorchamps Blancpain Endurance Series 23 25 / July / 2015 3 Day Event 5 Nürburgring ADAC GT Masters 21 23 / August / 2015 3 Day Event 6 Misano Blancpain Sprint Series 02 04 / October / 2015 3 Day Event Passes Each team will receive 11 passes per car per event, as follows: - 6 Pit Lane passes - 5 Paddock passes - 2 Team Park Passes Page 5 of 11
Financial Service Price in EUR Quantity ENTRY FEE (Including: 2x 60 minute of free practice, 2x 15 minutes of qualifying, 2x 50 minute + 1 lap races, TV production of both races, paddock allocation, 11 entry tickets (6 pit-lane and 5 paddock), 2 parking tickets, photo service) Early entry fee (Paid before 1st March 2015 guarantees entry and reduces Race-entry-fees) 1.500 Early entry fee Full season (Entry fee for all 6 events with advance payment before 1st April 2015) Early entry fee Race by race When participating during all 6 rounds in our 2015 season, we will give you a reduction of 1.500 in round 6 Late entry fee (Paid before 1st April 2015 guarantees entry) Late entry fee Full season Late entry fee Race by race When participating during all 6 rounds in our 2015 season, we will give you a reduction of 1.500 for in round 6 Single entry (Race-by-race single entry fee) Single entry fee - Round 1 - Nogaro Single entry fee - Round 2 - Zandvoort Single entry fee - Round 3 Redbull Ring Single entry fee - Round 4 Spa Francorchamps Single entry fee - Round 5 - Nürburgring Single entry fee - Round 6 - Misano Please Mark 12.000 2.500 (15.000) (13.500) 1.500 13.500 2.750 (16.500) (15.000) - - Every change of driver during the season will imply the payment of an extra entry fee of 250,-- -- Applications will only be accepted after prior settlement of all debts with GT-future Gmbh and its partners by the competitor or driver. Deposit Service Instead of many separate deposits, we ask you to transfer 500 deposit. Within this deposit are deposits for SPAA05, Transponders etc. this service is obligated. After receiving everything at the track in correct order the money will be refunded by bank within 14 days after the race/season 500 Name Bank Holder IBAN Number All prices are without VAT Page 6 of 11
Service Optional Services and Requests GoPro HERO 3 Silver Edition includes: Roll-Bar Mount, 12v USB Charger, Frame, Class 10 16GB Micro SD Card * please note that all our participants must have a GoPro 3 Onboard Camera Full Season Rental - Car Transponder Race by Race Rental Car Transponder Buying - Car Transponder (Mylaps/AMB) UPS Shipment Such as the GT4 European Series Sticker Set, Go-Pro Hero 3 to send to you in advance before the race Price in EUR Quantity Financial Please Mark 295 200 40 400 40 All prices are without VAT PAYMENT TO GT-future GmbH : By bank transfer in Euro (costs of transfer are payable by the sender), to the order of GT future GmbH, to: - Raiffeisenbank Much-Ruppichteroth eg - IBAN : DE63370695240009706011 - BIC : GENODED1MUC Specify reason for the transfer: GT4 European Series Season 2015 All Rounds/Round TEAM NAME Please send a copy of your bank transfer to: E-mail: info@gt4series.com Fax: +31 (0) 10 412 99 89 Page 7 of 11
LIABILITY WAIVER Entrant I hereby agree to my car: Make/Brand: Type: Chassis-No.: To Participate in the 2015 GT4 European Series season or in one of the following events in 2015: Track Event Date Event Type 1 Nogaro Blancpain Sprint Series 03 05 / April / 2015 3 Day Event 2 Circuit Park Zandvoort Pinksterraces 22 24 / May / 2015 3 Day Event 3 Redbull Ring ADAC GT Masters 05 07 / June / 2015 3 Day Event 4 Spa Francorchamps Blancpain Endurance Series 23 25 / July / 2015 3 Day Event 5 Nürburgring ADAC GT Masters 21 23 / August / 2015 3 Day Event 6 Misano Blancpain Sprint Series 02 04 / October / 2015 3 Day Event Name of Entrant / Competitor: Name of Car Owner: We confirm that we have read and understood the provisions of the International Sporting Code, the GT4 Technical and Homologation Regulations and the GT4 European Series Regulations and we agree, on our own behalf and on behalf of everyone associated with our participation in the 2014 GT4 European Series, to observe and be bound by them (as supplemented or amended). We declare that we have examined this and that the information given is true, correct and complete. We understand that any change to the details given on this must be notified to the GT- future GmbH in writing within 7 days of such change so that the GT-future GmbH may reappraise our entry. PLEASE NOTE THAT FAILURE TO NOTIFY GT-FUTURE GMBH OF ANY CHANGES MADE TO THE DETAILS SUPPLIED ON THIS FORM MAY RESULT IN YOUR EXCLUSION FROM THE SERIES. Place and date: Car Owner Name and Signature: Entrant Name and Signature: Page 9 of 11
LIABILITY WAIVER Driver 1 I hereby declare: First Name: Last Name: License No.: that I have taken due notice of the terms of the Sporting and Technical Regulations including the liability waiver contained therein, and agree to abide to them. I certify that the particulars given on this are correct and that the car entered will comply in all respects and throughout the whole event with the provisions of Appendix J of the International Sporting Code and especially with the safety prescriptions. And I acknowledge that I understand the nature and type of the competition (GT4 European Series) and the potential risk inherent with the motor sport and fully agree to accept this risk. Date: Place: Signature.: Page 10 of 11
LIABILITY WAIVER Driver 2 I hereby declare: First Name: Last Name: License No.: that I have taken due notice of the terms of the Sporting and Technical Regulations including the liability waiver contained therein, and agree to abide to them. I certify that the particulars given on this are correct and that the car entered will comply in all respects and throughout the whole event with the provisions of Appendix J of the International Sporting Code and especially with the safety prescriptions. And I acknowledge that I understand the nature and type of the competition (GT4 European Series) and the potential risk inherent with the motor sport and fully agree to accept this risk. Date: Place: Signature.: Page 11 of 11