MUCO RunForAir 2012 - REGISTRATION

Group name 20km Brussels : muco

REGISTRATIONS RECEIVED

AFTER MARCH 10th 23h59

WILL BE ON THE WAITING LIST.

NO PAYMENT NEEDED TIL YOU RECEIVED

E-MAIL CONFIRMATION ON YOUR PARTICIPATION

IN THAT CASE.

 

Welcome ! - Please fill in below

 

Name:

 
First Name:

 
Street and Number:

 
Postal Code:

 

  
City:

 
Country (BEL, FRA, ...):

 
Nationality (BEL, FRA, ...):

 
Birth Date (dd/mm/yyyy):

 
Sexe (Man : M - Female : F):

 

  
Language (NL, FR, ENG, ...):

 
Telephone Number (Mobile preferably):

 
E-mailaddress:

 
Time on 20k (estimated : ex. 01:55):

 
Size T-shirt (S / M / L / XL / XXL):

 
Comments: