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							                                                                                              2012 WRC - Registration Form WRC Team




                       FEDERATION INTERNATIONALE DE L'AUTOMOBILE



                                 2012 FIA WORLD RALLY CHAMPIONSHIP
                                   REGISTRATION FORM – WRC TEAM



THE APPLICANT

Full company name                       ..............................................................................................................

Country of registration                 ..............................................................................................................

Registration number                     ..............................................................................................................

Date of registration                    ..............................................................................................................

Registered office                       ..............................................................................................................
                                        ..............................................................................................................
                                        ..............................................................................................................
                                        Tel .........................................................................................................
                                        E-mail....................................................................................................

Trading address
(If not the registered office)          ..............................................................................................................
                                        ..............................................................................................................
                                        ..............................................................................................................
                                        Tel .........................................................................................................
                                        E-mail....................................................................................................

Directors                               ..............................................................................................................
                                        ..............................................................................................................
                                        ..............................................................................................................
                                        ..............................................................................................................
                                        ..............................................................................................................
                                        ..............................................................................................................

Team Principal                          ..............................................................................................................
                                        ..............................................................................................................
                                        ..............................................................................................................
                                        Tel .........................................................................................................
                                        Mobile ...................................................................................................
                                        E-mail....................................................................................................




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                                                                                            2012 WRC - Registration Form WRC Team




Team Manager                          ..............................................................................................................
                                      ..............................................................................................................
                                      ..............................................................................................................
                                      Tel .........................................................................................................
                                      Mobile ...................................................................................................
                                      E-mail....................................................................................................

Team Engineer                         …. .........................................................................................................
                                      ..............................................................................................................
                                      ..............................................................................................................
                                      Tel .........................................................................................................
                                      Mobile ...................................................................................................
                                      E-mail....................................................................................................

Authorised representatives               ............................................. Title ......................................................
with sole power to bind the company      ............................................. Title ......................................................
                                         ............................................. Title ......................................................



DETAILS OF APPLICANT

Entrant national competition             ............................................. issued by ..............................................
Licence number

Entrant name                          ..............................................................................................................
(As mentioned on the licence)

We confirm that we are a WRC Team wishing to take part in the World Championship events with cars of the
same make and hereby apply to enter the 2012 FIA World Rally Championship.

   Make name                          ..............................................................................................................




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                                                                                                                    2012 WRC - Registration Form WRC Team




We undertake to participate in each of the 7 or more nominated rallies, in accordance with Article 7.3.1 of the
2012 FIA World Rally Championship Sporting Regulations. These rallies are:


1.            17-22 January                        Rally Monte-Carlo (MCO)                                                                    

2.            09-12 February                       Rally Sweden (SWE)                                                                         

3.            08-11 March                          Rally Mexico (MEX)                                                                         

4.            29 March – 01 Apr.                   Rallye de Portugal (PRT)                                                                   

5.            27-29 April                          Rally Argentina (ARG)                                                                      

6.            25-27 May                            Acropolis Rally of Greece (GRC)                                                            

7.            22-24 June                           Rally of New Zealand (NZL)                                                                 

8.            02-08 August                         Rally Finland (FIN)                                                                        

9.            24-26 August                         ADAC Rally Deutschland (DEU)                                                               

10.           13-16 September                      Rally of Great Britain (GBR)                                                               

11.           04-07 October                        Rallye de France - Alsace (FRA)                                                            

12.           18-21 October                        Rally d’Italia (ITA)                                                                       

13.           01-04 November                       RallyRACC Catalunya-Costa Daurada (ESP)                                                    

(Please tick the 7 or more relevant boxes corresponding to your 7 or more nominated rallies)



We confirm that we have read and understood the provisions of the International Sporting Code, the
Technical Regulations applicable to the group of cars scoring points in the 2012 FIA World Rally
Championship (Group A of Appendix J and World Rally Cars) and the 2012 FIA World Rally Championship
Sporting Regulations. We agree to be bound by them (as supplemented or amended) and furthermore we
agree on our own behalf and on behalf of everyone associated with our participation in the 2012 FIA World
Rally Championship to observe them. We declare that we have examined this Registration Form and that the
information given is true, correct and complete.

SIGNED BY              ..............................................................................................................…………. (SIGNATURE)


                ..................................................... ............ …… (PRINT NAME OF THE PERSON SIGNING)
Being a person duly authorised
to sign for and on behalf of

                       ............................................................................... … (PRINT FULL NAME OF APPLICANT)

Date ......................................................................................................................................................................




Thank you to return this form, duly completed and signed to the following e-mail address: acrepin@fia.com


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