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Giro delle Dolomiti 2010
Individual entry
Association*:
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Distance assoc.seat.km*
Federation
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Name*:
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Phone:
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Sex*:
male
female
Type*:
amateur
tourist
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Type of participation:
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BANK
IBAN: IT 98 T 06045 11600 000005001882
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Note:
Consent of the participant to the treatment of personal data
The undersigned, in compliance with the law 31/12/1996 n.675 (regarding the tutelage of persons concerning the treatment of personal data), allows you to use his personal data for the purposes concernig your activity. He acknowledges moreover that the treatment of data will be done through tools suitable to assure security and secrecy and also suitable to record, to manage and to transmit data.
Declaration
The undersigned declares to be in a good state of health, to be in possession of a health certificate for cycling practice (amateur or tourist), to have read the program and to be aware of it, of routes with corresponding altimetry and to agree to the regulations.
Fields marked with asterisk (*) are mandatory.
Visitor nr.
A.S. Giro delle Dolomiti - S.V. Dolomiten-Radrundfahrt
Via Vittorio Veneto, 5 - 39100 Bolzano (BZ) - Tel: (+39) 0471 272089 - Fax: (+39) 0471 270443 - P.iva: 01649970215