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[]
[]
[]
[]
[]
[{"$nulls":27},"28, 29 y 30 ABRIL 2023"]
["ECO RALLYE VILLA DE LLANES",{"$nulls":16}," SOLICITUD DE INSCRIPCIÓN "]
["DIRECCIÓN : POSADA HERRERA, 1 ",{"$nulls":16},"            Fecha y hora recepción",{"$nulls":9},"       Nº Entrada",{"$nulls":5},"   Nº Rallye"]
["C.P.  33500"]
["Tel :  985 40 05 22",{"$nulls":16},"     Fecha"]
["Móvil:  629650608"]
["E - mail :  secretaria@rallyellanes.com",{"$nulls":16},"Hora"]
["Web :  www.ecorallyellanes.com"]
[]
["CONCURSANTE",{"$nulls":28},"Nº Licencia"]
["EQUIPO"]
[" "]
["PILOTO",{"$nulls":6},"Nombre",null,null," ",{"$nulls":18},"Nº Licencia"]
["Apellido 1º",{"$nulls":16},"Apellido 2º"]
["Dirección",{"$nulls":28},"Número/Piso"]
["Población",{"$nulls":16},"Nº DNI",{"$nulls":11},"Nacionalidad"]
["Cod.Postal",{"$nulls":16},"Teléfono",{"$nulls":11},"Tel. Movil"]
["E-mail"]
[]
["COPILOTO",{"$nulls":6},"Nombre",{"$nulls":21},"Nº Licencia"]
["Apellido 1º",{"$nulls":16},"Apellido 2º"]
["Dirección",{"$nulls":28},"Número/Piso"]
["Población",{"$nulls":16},"Nº DNI",{"$nulls":11},"Nacionalidad"]
["Cod.Postal",{"$nulls":16},"Teléfono",{"$nulls":11},"Tel. Movil"]
["E-mail"]
[]
["VEHÍCULO",{"$nulls":6},"Marca",{"$nulls":19},"Modelo"]
["Año de fabricación",{"$nulls":26},"Color"]
["Matrícula",{"$nulls":26},"Nº bastidor"]
["País de Matriculación",{"$nulls":26},"Combustible"]
[]
["CATEGORÍAS",null,null,"ELÉCTRICO",{"$nulls":12},"Tipo de conexión"]
[null,null,null,"HÍBRIDO ENCHUFABLE"]
[{"$nulls":16},"Gasolina",{"$nulls":4},"Gasoil",{"$nulls":4}," ",null,null,null," ",null,null,null," "]
[]
[null,null,null,"HÍBRIDO"]
[{"$nulls":16},"Gasolina",{"$nulls":4},"Gasoil",{"$nulls":4}," ",null,null,null," "]
[]
[]
["DERECHOS DE INSCRIPCIÓN",{"$nulls":28},"Importe Euros",{"$nulls":4}," Total Euros"]
["CON la publicidad del Organizador ",{"$nulls":28},325]
["SIN la publicidad del Organizador ",{"$nulls":28},650]
[]
["Road-Book en papel",{"$nulls":15},"SI",{"$nulls":4},"NO"]
[]
["DATOS FACTURACIÓN"]
["Razón social",{"$nulls":30},"CIF"]
["Dirección",{"$nulls":30},"C.P."]
["Localidad"]
["Provincia",{"$nulls":30},"Pais"]
[]
["Importe Total a Ingresar en CAJA RURAL DE ASTURIAS : "]
["NUMERO DE CUENTA:"]
["ES11-3059-0055-4025-1295-3429"]
[]
[" El firmante se hace responsable de los datos que figuran en este documento y declara conocer y aceptar los reglamentos por los que se rige la    "]
["prueba, y solicita su inscripción en el 6º ECO RALLYE VILLA DE LLANES."]
[]
[]
["Fecha"]
[]
[{"$nulls":7},"Firma del Concursante",{"$nulls":14},"Firma del Piloto",{"$nulls":13},"Firma del Copiloto"]