REGISTRATION FORM

 
(*) Name  
(*) First name  
(*)Place  
Postnr. (*)City
(*)Day of birth  
Telefon  
e-mail  
Motomark 1 type Capacity cc  
Motomark 2 type Capacity cc  
Motomark 3 type Capacity cc  
   
Wish information  of tel. the president +32.476-737.303 / 056-776.005  
Wish to pay bay way of reknr.
385-0586799-12
20,00€/year/address
Man Wife    
Pilot
Duo
   
       
(*) Obliged fill