2021- 2022 UAE ProCar Championship REGISTRATION FORM

UAE ProCar Championship Registration Form 2021/2022 Page 1 of 2

Season Registration Form

I hereby apply for registration for the UAE ProCar Championship 2021/22.

Driver Name: _______________________ Nationality: _______________________

Mobile No.: _______________________ E-Mail Address: _______________________

Race License No.: _______________________ Issued By: _______________________

Address: ______________________________________________________________________

City/Country: _______________________ P.O. Box: _______________________

Name of Entrant: ______________________________________________________________________ (if different)

Mobile No.: _______________________ E-Mail Address: _______________________

Entrant License No.: _______________________ Issued By: _______________________

Address: ______________________________________________________________________

City/Country: _______________________ P.O. Box: _______________________

Please specify contact for all correspondence Driver Entrant

Previous racing experience of driver:

PLEASE ATTACH RACING HISTORY CV GIVING AS MUCH INFORMATION AS POSSIBLE.

Car Details

Make: _______________________ Model: _______________________

Year: _______________________ cc: _______________________

Turbocharged or Supercharged: _____________

Declared Weight of car (Tech. Regs. Art 17): _____________

Stated power level (bhp at the wheels) _____________ (please provide certificate)

2021- 2022 UAE ProCarChampionship REGISTRATION FORM

UAE ProCar Championship Registration Form 2021/2022 Page 2 of 2

Roll Cage Make: _______________________

Fuel Cell Make: _______________________

If exception under Tech. Regs. Art. 5.1. k), date applied for:

EMSO Car Passport: _______________________

Transponder Model: _______________________

Declared Rev. Limit: _______________________

Date of Dyno Test: _______________________

Dyno sheet attached:

Class entered

Class 1: 2wd exceeding 2000cc

Class 3: Homologated GT3 cars

Class 5: Cup and Challenge cars

Class 6: GT or mass production-based cars that do not comply with Classes 1 - 5

Certificated By: _______________________

FIA Number: _______________________

_____________

Transponder No.: _______________________

Class 2: 2wd between 1600 – 2000cc

Class 4: Homologated GT4 cars

Proto Class:

Clio Cup Class

AE86 Class:

Preferred Car Number

N.B. Numbers issued on a first come/first served basis at the final discretion of the Organizers.

Season Registration Options

Season Registration only (AED 2,100 incl. VAT, to be paid before start of the season

Early Bird Full Season (AED 15,540 incl. VAT, valid until 1 October 2021)

I hereby certify that all the information given above is accurate and true. (The Series regulations, Judicial Arrangements and Commercial Undertakings are to be followed)

Name: _______________________ Signature: _______________________ Date: ____________

To submit your entry, please send the completed form to: DAMC, Dubai Autodrome, P.O. Box 57331, Dubai, UAE or email to: dominics@dubaiautodrome.com

[including all Renault Clio Cup Gen 3]

[For all Renault Clio Cup Gen 5]