Registration 17th Race for Haiti - 2009

The registration will be valid when we'll recive a copy of the payment receipt.
The fields in blue are required.

First name			Last name
Address (street, n.)			Postal Code
City			Country
Phone number (phone/mobile)			Email
Birth Year	select... 2007 2006 2005 2004 2003 2002 2001 2000 1999 1998 1997 1996 1995 1994 1993 1992 1991 1990 1989 1988 1987 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930		Sex	Male Female
Card number			Type	Amatuer cyclist Sportsman cyclist
Team			Code
Affiliation	UCI        FCI        UDACE        CSI        Other
Participates to Alpe Adria Tour?		Yes        No		If yes select... Subscription (€ 115) Only registration (€ 10)
Registration to Alpe Adria Tour route:		Average fund     Great fund
Participates in the Combined Standings?		Yes        No
Payment of subscription made with
Bank Transfer		Other:
On date
Even those who carry out the On-line registration must send by fax (0432 699 706) a copy of the receipt of payment, together with the photocopy of valid sports card.
Notes: