Virée des Ballons Registration

"*" indicates required fields

1Pilot

2Copilot

3Car

4Options

Pilot

Sex*

First name*

Name*

Your address (Number and street)*

Postcode*

Town*

Pays*

Mobile phone*

E-mail*

Licence number*

Co-pilot

Sex

First name

Name

Your address (number and street)

Postcode

Town

Pays

Mobile phone

E-mail

Licence number

Your car

Brand*

Model*

Engine capacity

Serial number

Year of manufacture*

Registration*

Date of technical inspection*

Nom et lieu du centre de contrôle*

Insurance company*

Contract no.*

Pre-sale options only

PILOT PACK

including, road book, a set of 2 door stickers and 1 T-shirt

PILOT PACK

Price: 39,00 €

Rally Pack

including a road book, a set of 2 door stickers, 1 Rallye plate and 1 T-shirt

Rally Pack

Price: 49,00 €

T-shirt

Price: 19,00 €

PLAQUE

Price: 12,00 €

Total

Number of plain unisex T-shirts counted (pack and individual)

T-shirt size S

T-shirt size M

T-shirt size L

XL T-shirt

XXL T-Shirt

T-shirt size XXXL

Methods of payment*

Bank card

PayPal

Bank transfer

Cheque (French banks only)

Bank card

PayPal

You will receive payment instructions by email.
As a reminder, your application will not be accepted until we have received your payment.