Altertour Individual Registration Form .... 3. a copy of your Civil Responsibility insurance ; ... o Children stay under the responsibility of their referent adult.
Altertour Individual Registration Form Bikers charter, please turn the page (to be undersigned) First name, Family name: __________________________________
size (T-shirt / bike): _________
Address: ______________________________________________________________________ Tel: ________________ Mobile: _________________ Email: _______________________ Age: ______ if you are under 18, name the person who accompanies you on the tour :____________________ Are you vegetarian? Yes / No Alterbikes will be shared. Do you wish to bring your own bike (*)? : ____ Will you bring your tent? ____ What distance will you intend travel at once during a half-day stage? Morning: 10 mi
20 mi
30 mi
40 mi
50 mi
Afternoon: 10 mi
20 mi
30 mi
40 mi
50 mi
Mark in the table below, your meals and lodging choices, and work out the total cost (reduced for -12 years: free lodging)
10 € Participation in the obligatory Altertour insurance 10 € TOTAL : (*) Bikes will not be transported. Therefore, if you bring your bicycle: you may either lend it to other participants when you do not use it, or use it all along the stages you’ll have chosen.
Postal mail to be sent before the 20th of June to the following address:
Altercampagne 49, rue de Paris 78460 CHEVREUSE FRANCE Including: -
1. The Altertour Individual Registration Form ; 2. a medical certificate of no counter-indication to cycling, or a copy of licence if member of a sport federation ; 3. a copy of your Civil Responsibility insurance ; 4. cheque to : Altercampagne Altercampagne ; 5. Parents of under age participants should sign an approval form for a possible medical surgery.
Charter of Alterbikers I pledge my word to respect the following solidarity and security points: o
Driving rules.
o
Helmet.
o
Using a race bike is not adapted to the tour.
o
Tour to be cycled at least by two.
o
Altertour T-shirt while cycling.
o
Children stay under the responsibility of their referent adult.
o
Personal vehicles will not be allowed to go with alterbikers.
t Check payable to « ITO - colloque» t Bank transfer IBAN FR76 3000 3035 0100 0501 2961 754. BIC. SOGEFRPP. Please return this form with your payment to:.
7â25 July 2003. Aix-en-Provence, France. PARTICIPANT REGISTRATION FORM. Please return this completed form before February .... Place of birth, country.
I give my consent for Les Petits Grands Lecteurs to take my child in photo or video for advertising reasons related to youth programs (eg, leisure guide). *. I Oui.
6 oct. 2017 - liter le parcours des gens qui ont choisi l'activité physique comme premier ... Julie-Christine enseigne en techniques d'éducation spécialisée au Cégep de ... Autant dans son parcours professionnel que sportif, elle privilégie la .... S
Deadline to register: Friday, May 18. Date limite pour inscrire: vendredi, 18 mai. Note: Members who are single parents, parents attending Congress on their own ...
1. Personal Information (the fields marked with * must be completed). * Title. * Name: * First name: Organisation/Company: Organisation type (please stick one):.
B. VEHICLE INFORMATION (If more than one vehicle, use a Vehicle Reading form che descriptive for every other vehicle.) Year: Make: Model: Color: Body: Series/Trim: # VIN: Odometer: KMS. MILES. Distance Travelled Unknown. Please explain (select most a
Jan 15, 2009 - Please ensure that your bank covers any transfer charges. Please make checks payable to S.O.O.N. [Design Research Foundation]:. S.O.O.N..
Aug 28, 2004 - PERSONAL DETAILS. Mr. Mrs. Miss Dr. Prof. Last Name: First Name: Company / Institution: Position: Street / P.O. Box: Zip code: City: Country:.
Traitement médical. Le Collège du Léman est habilité à prendre toutes les mesures nécessaires pour la sauvegarde de la santé et du bienR être de l'élève.
Phone number: (ultra trail and 59km: cellphone mandatory day of racing to confirm the registration) : E.mail: ... Dormitory Friday night and. Available from 8 pm.
inscription à la conférence et de votre demande d'adhésion au groupe ... vous diffuser les publications, à vous pourvoir les privilèges de votre adhésion, à vous.
To be filled out by the applicant or person responsible for the applicant who has a .... may be disclosed by Hydropothecary to: (a) Authorized Third Parties, (b).
