Para-cycling European Cup 2010

REGISTRATION FORM

Date of the race: 29-30th September 2012
Please complete all of the required and relevant details on the form below.

Athlete Personal Details
First name / Jméno:	* required
Last name / Příjmení:	* required
Date of Birth / Datum narození:	* required dd-mm-yyyy
Gender / Pohlaví:	* required
Nationality / Národnost:	* required

Athlete Contact Details
Email:	* required
Phone number / Telefonní číslo:

Athlete Address
Street Address / Ulice, č.p.:	* required
City/Town/Village / Obec:	* required
Postcode / PSČ:	* required
Country / Stát:	* required

Athlete Race Details
Time trial / Road race:	Time trial race Road race Time trial race + Road race
UCI-Code / kód UCI:	* required
Team or Club / Tým nebo klub:
Classification / Klasifikace:	* required

Agreement Terms and Conditions With my participation to an event of the UCI Para-cycling European Cup I acknowledge the liability exclusion of the organizator or of involved third party for personal or material damage. I hereby certify that I have full knowledge of the risks involved in this event and that I am physically fit and I have sufficiently trained to participate.

Accept Agreement:	* required Please tick this box to confirm that you have read and agree to terms and conditions of this agreement as stated above, and the details you have given above are correct.
Rewrite this code (opište tento kód) >