Application for participation in: - Mercedes-Benz Clubs

Application for participation in:
Mercedes-Benz & Friends Please return to:
Mercédès – mon amour Mercedes-Benz Museum GmbH
From 21/04 to 25/04/2011 Anette Hufnagel
Club Management
Cabin booking: HPC R051
King-size bed D – 70546 Stuttgart
Twin bed Fax +49-(0)711 - 3052123216
E-Mail: anette.hufnagel@daimler.com
Surname of driver Surname of passenger
First name of driver First name of passenger
Address Address
Postal/zip code / city Postal/zip code / city
Country Country
Driver’s date of birth Passenger’s date of birth
Driver’s place of birth Passenger’s place of birth
Passport/ID card no. Passport/ID card no.
Citizenship Citizenship
Date issued Date issued
Expiration date Expiration date
Place issued Place issued
Mobile/cell phone Mobile/cell phone
Mail Mail
Eatables intolerance Eatables intolerance
Allergy Allergy
Club name
Vehicle License plate number
Model Year
Do you need underground parking? Are you interested in shipping your vintage car with a classic car transport company? (any costs are
invoiced with the receipt)
Please contact us. We are happy to assist you.
Participation is limited. Museums GmbH reserves the right to select the participants from among the applicants.
I herewith apply for participation and accept fully the terms and condition of the invitation and participation.
Place, date, driver _________________________ Driver’s signature _______________________
Place, date, passenger _________________________ Passenger’s signature_______________________
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Privacy Statement:
I herewith agree that the information collected within the context of this contact, can be processed and utilized by Daimler
AG and its sales and service partners as well as Mercedes-Benz Museum GmbH to inform me and advise me on products
and services of the Daimler Group and for the purpose of market research. For this purpose, Daimler AG may transfer this
information to the appropriate dealer/service partner within the Daimler sales and service organisation and market
research institutions.
You may contact me ( ) by phone and fax
( ) by e-mail and SMS
( ) I prefer not to receive any information by mail
If you wish to object to the processing and use of your information at a later date, please contact Mercedes-Benz Museum
GmbH, “Privacy Protection” Mercedesstr. 100, D-70372 Stuttgart. Unfortunately, we can then no longer provide any
assistance and information.
Place, date _________________________ Signature ________________________
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1. Event / Organizer
Additional Information
Organizer is Mercedes-Benz Museum GmbH, 70567 Stuttgart (hereinafter called “organizer”).
Only members of recognized Mercedes-Benz Clubs are eligible to participate (hereinafter called “participant(s)”).
The event is an international, sportive, touristic, cultural, and societal meeting with Daimler, Benz, and Mercedes-Benz
cars. It will take place between 21/4 – 25/4/2011 in accordance with the invitation subject to a possible later change by
the organizer.
The fee for participation (see Item 3) includes the following services:
The event, “Mercedes-Benz & Friends. Mercédès – mon amour,” is a drive with vintage cars along the Cote d`Azur in
combination with a trip aboard the cruise ship “Le Boreal” from 21/4 – 25/4/2011. The ship serves the guests as
hospitality area after the drives. There is one double cabin (two separate beds is a possibility) per vehicle for the overnight
stays. In addition, breakfast, lunch, and dinner including beverages (“open bar”), minibar, travel documents, guarded
parking for the classic cars during the night at the open space at the port and at the day of transfer to Corsica are included
in the fee, so is contacting a towing service during the journey and small repairs exclusive of any spare parts.
During the 4 event days, the ship takes you for one day to the island of Corsica for shore excursions. The cities Marseille,
St. Tropez, Nice, and Monaco are integrated into the event programme.
2. Deadline / Requirements of Participation / Confirmation of Participation
The deadline for the application is 25 February 2011
The number of cars and participants is limited.
By the end of February 2011, the organizer selects the participants among the received completed application documents.
Participation is confirmed by 4 March 2011.
By submitting the application, the applicant confirms:
a) membership in a Mercedes-Benz Club
b) that he or she has a valid driver’s license
c) that the vehicle is properly registered
d) liability insurance coverage of at least € 2.5 million for personal injuries and
€ 500,000.00 for property damages
The organizer reserves the right to reject an application without stating any reasons.
3. Payment Terms
In case, the participant receives confirmation, there is a participation fee in the amount of
per vehicle including one driver and one passenger.
€ 1,900.00
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The participants receive from the organizer a separate invoice for the above referenced amount, which the participant
must pay to the following account writing the following in the subject line:
4. Road Safety of the Cars
“Mercédès - mon amour, your first and last name, invoice number”
Deutsche Bank AG, Stuttgart
BLZ/routing number: 600 700 70
Account number: 1626076
IBAN: DE 60 600 700 70 0162607600
BIC / SWIFT Code: DEUT DE SS
Each participant is solely responsible for the road safety of the vehicle he or she drives.
The following documents must be carried during the trip:
- valid registration for the vintage car
- proof of an effective liability insurance (minimum coverage of € 2.5 million for personal injuries and €500,000
for property damages)
- “Grüne Versicherungskarte” (=international insurance certificate, mandated by law for foreign license plates)
5. Driving Behaviour
All participants must follow road regulations. Each severe violation of these regulations leads to an exclusion. The
instructions of the lead driver and those of officials, who are visually marked, must be followed. Any cars, which become
unsafe for the road or inoperable during the excursions, will be excluded from the trip.
6. Modification of Services
The key services (see Item 1) listed, may only be changed or modified if it is absolutely necessary and not caused by bad
faith of the organizer and only if the modifications are not significant and do not hamper the overall design of the above
referenced services. Unaffected therefrom are possible warranty claims provided the services are non-conforming. The
organizer shall promptly notify the participants of any significant change in services.
7. Animals
During the entire time of the event, all participants are prohibited from taking animals with them. In case of violations,
the organizer reserves itself the right to exclude the participant in violation.
8. Contact Information
Anette Hufnagel
Mercedes-Benz Museum GmbH
Club Management
HPC R05
D – 70546 Stuttgart
Tel. +49 (0) 711-17-8 4067 ; Fax. +49 (0) 711 - 3052123216
E-Mail: anette.hufnagel@daimler.com
www.mercedes-benz-clubs.com
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