A) Class. B) Team and motorcar information. Registration form for The 100 Miles of Amsterdam December 17 th 2017

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1 Registration form for The 100 Miles of Amsterdam December 17 th 2017 A) Class Sport class More competitive, serious navigating, prices Touring class Enjoying the route, detailed road book B) Team and motorcar information Driver: Mechanic: Name: M/F Name: M/F Address: Address: City: City: Zip: Zip: Country: Country: Mobile phone nr.: Mobile phone nr.:

2 Car: Year (first registration): Marque: Coachbuilder: Engine Type/Year: Engine capacity (cc) Has the engine been modified since original? Please explain: Has car been modified from its original manufacturing specs.? If yes, what and when? Please explain: Car (Racing) History (will be provided to announcer) Please two pictures of the car to

3 B) Payment options 1) We want an invoice on my company name and want to support the The 100 Miles of Amsterdam. My company or I want to become a Friend of The 100 Miles and get free registration. see Registration Registration fees. ( 575,- + 21% VAT = 696, -) My company or I want to become a Sponsor of The 100 Miles and get free registration. see Registration Registration fees. ( 1.000,- + 21% VAT) My company or I want to become a Partner of The 100 Miles and get two free registrations. see Registration Registration fees. ( 2.000,- + 21% VAT) Company details: Name: VAT number: Please send the logo of your company. 2) We want to support War Child. The 100 Miles of Amsterdam is held the week before Christmas. A good moment to think about the less fortunate and to give. The 100 Miles of Amsterdam is therefore sponsoring War Child. I or my company (please give name to be mentioned on the website) want to sponsor War Child with (minimum 200, -). Since I support War Child, I get a reduction of 50,- on the regular registration fee. Please transfer the amount to War Child; IBAN: NL24INGB BIC: INGBNL2A DO NOT FORGET to mention the payment reference

4 3) We want to participate to The 100 Miles of Amsterdam, starting Sunday December 17, NB: The amounts are net, no VAT is deductible. The 100 Miles is subject to the rulings for travel agencies. Since I am a Friend/Sponsor/Partner of The 100 Miles I do get free registration. Since I support War Child I do get a reduction of 50, - on the regular registration fee. (-/- 50) Registration fee: 475, - (one car with two occupants).. (please fill in) Extra diners at 60, -.. (please fill in) Extra late supper at 15, - The amount of has been transferred to the account of The 100 Miles B.V., Amsterdam; ABN Amro account: IBAN: NL64ABNA BIC: ABNANL2A

5 C) Conditions The event is open to a maximum of 50 cars. The allocation will be on the basis of first register & first pay. In the case the organisation cancels the event due to force majeure 50,- of the registration fee will be restituted. In the case the organisation cancels the event due to a lack of registrations a total refund will be given. In the case of a cancellation by the participant before November 15th a refund of 50% of the registration fee will be given. The organisation reserves the right to bring in minor changes into the programme. The driver agrees to (or certifies) the following the car is insured and complies with all regulation on roadworthiness. to have checked with the insurance company if they cover an event like The 100 Miles of Amsterdam. to indemnify and hold harmless the organisers of the event and all other bodies or companies and individuals associated with or participating in the event (and their respective employees and agents) against all proceedings, damages, liabilities, costs and expenses arising out of any act, default, negligence or breach of statutory duty on our part. the vehicle entered will be covered by valid insurance for third party liability by law while driven by any member of its crew during any part of the event. to respect all the road regulations, especially those about speed limitations. to respect the public and the nights rest in the villages, which will be encountered. to have read and understood the regulations on The 100 Miles website and that the car complies to those regulations. Link to regulations: >click< Signature driver:

6 Please check the appropriate boxes ( )and send this signed registration form to: The 100 Miles BV Achterstraat AB Goedereede The Netherlands Laurens@the100miles.com Registrations can only be seen as complete if the full payment has been received.