"Les 9 clochers", Sunday October 14th 2012 â Registration form
Registration form. To send back ... Birth date : / / 19 . ... I HAVEN'T SPORT LICENSE : I join a Medical certificate delivered after October 14th, 2017 with the.
" Les 9 Clochers en Beaujolais “ 2018, October Saturday the 13th and Sunday the 14th
Registration form To send back before Tuesday, October 11th to "Les 9 Clochers 1 Avenue de la République 69380 Chazay d'Azergues France" Choose your course 2 Clochers ( 6 Km )
5 Clochers ( 12 km )
9 Clochers ( 25 km )
Foulée jeunes
11,00 €
13,00 €
2€ (Saturday )
8,00 €
Payment during the withdrawal of your number (1 bulletin by runner - Write in capital letters PLEASE)
Name :
________________________ First Name : ____________________
Men - Women ( Surround the good answer)
Birth date :
… / … / 19 …. (Day – Month – Year)
Your adress :________________________________________________________________________ City :
___________________________
Country : _____________________________________
ZIP Code : _______________________ Email : ____________________________________@__________________________________________ I participate Team challenge ( check this box if you participate in the team challenge ) Team name : ___________________________________________________________ Mark one of the following compartments: I HAVE A SPORTS LICENSE : I join the photocopy of my valid license on October 14th, 2018 I HAVEN'T SPORT LICENSE : I join a Medical certificate delivered after October 14th, 2017 with the mention: not contraindication of the practice of the athletics in competition or from the running in competition. No other description will be accepted Compulsory parental consent for the minors been born after October 13th, 2000 Supplement to the photocopy of the license or the medical certificate.. I authorize my son - my daughter to participate in the test (See his inscription above) I also authorize him to receive all the first aid which is necessary in the event of an accident; And after advise from an doctor, be transported to the hospital in the event of an emergency, and to carry out any urgent surgery if necessary Name : __________________________
First Name : _____________________
Date : __________________________ Signature : The inscription will be refused in absence of one of the wanted documentary evidences (law N 99-223 of March 23rd, 1999).Extract of the regulation: " Any inscription involves the apprehension and the whole acceptance of the regulation of the running "
"Les 9 clochers", Sunday October 14th 2012 â Registration form. To send back before ... MEN - WOMEN ( Surround the good answer) Date of birth: ⦠/ ⦠/ 19 â¦
"Les 9 clochers", Sunday October 14th 2012 â Registration form. To send back before ... MEN - WOMEN ( Surround the good answer) Date of birth: ⦠/ ⦠/ 19 â¦
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:.
For all other graduates and the not graduates, a medical certificate carrying the ... case of fixed price, except presentation of a medical certificate justifying this.
Security will be provided until 12pm (signalers, rescue workers, doctors, car ... and unlicensed, a medical certificate marked "non-cons to the practice of athletics.
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.
Altertour Individual Registration Form .... 3. a copy of your Civil Responsibility insurance ; ... o Children stay under the responsibility of their referent adult.
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.
... be assured until 12h (signalers, rescuers, doctors, car broom, commissaires). ... To be registered, any registration requires the provision of medical evidence ...
Problème n°2 (logiciel de gestion de la batterie) : certains appareils PAD ... Lorsque vous aurez reçu ce câble de données, connectez votre appareil à un.
d'arrêt cardiaque soudain (ACS) : Problème n°1 (marche/arrêt) : l'appareil s'allume sans intervention de la part de l'utilisateur. Lorsque cette situation se produit, ...
