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: