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24MX ALESTREM 2018 Waiting List

Since December 5th, the 24MX ALESTREM is full. Following the influx of riders demand. And in order to have more responsiveness if places were released, we decided to open a waiting list. Thus, if you wish to have a chance to take the start of the 4th edition of 24MX ALESTREM, we invite you to fill in this form!

CAUTION: Completing this information does not guarantee a place. Requests will be processed in order of arrival.

Nom / Prénom (Name / First Name)

Date de Naissance (Birt date)

Lieu de Naissance (Birth Place)

Adresse (Address)

Code Postal (ZIP CODE)

Ville (City)

Sexe (sex)

Nationalité (Nationality)

Mail

Moto Club

Numéro de Permis (Driving License Number)

Date du Permis (Driving License Passing Date)

Compagnie d'Assurance (Insurance Company)

Numéro de police d'assurance (Moto insurance number)

Phone

Type de Licence (License)

N° Licence si NCO (NCO License Number if National License)

Taille Maillot Kenny (Motorcycle Jersey Size)

Marque de moto (Motorbike brand)

Modèle de moto (Motorbike model)

4 Temps (Stroke)

2 Temps (Stroke)

Téléphone Assistance (Assistance crew phone number):

Numéro d'immatriculation (Plate number)

Catégorie

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