Pro km/Runde___________________EURO

Name:______________________________________________________________________

Unterschrift des Sponsors: ______________________________________________________ 

Straße:_____________________________________________________________________

PLZ, Ort:____________________________________________________________________

Pro km/Runde___________________EURO

Name: ______________________________________________________________________

Unterschrift des Sponsors:______________________________________________  

Straße: _____________________________________________________________________

PLZ, Ort: ____________________________________________________________________

Gesamtkilometer/Gesamtrunden:__________________________________________________

Gesamtsumme:________________________________________________________________

Ort, Datum:  __________________________________________________________________