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INSCRIPTION |
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11θmes Calades de Gordes |
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Catιgorie |
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Dossard N° |
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NOM:___________________________ |
PRENOM:_______________________ |
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ANNEE DE NAISSANCE:_____________ |
HOMME: |
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FEMME: |
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ADRESSE:_______________________________________________________ |
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VILLE:____________________________CODE
POSTAL:_________________ |
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TEL:________________________EMAIL:______________________________ |
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LICENCE FFC: |
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UFOLEP |
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FSGT |
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AUTRE |
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N° LICENCE:______________________ |
CLUB:______________________________ |
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NON LICENCIE: |
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Joindre certificat
mιdical et autorisation |
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parentale pour les
mineurs. Individuelle accident non couverte. |
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VOTRE |
CATEGORIES |
AGES |
KMS |
DEPART |
TARIF |
TARIF |
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CHOIX |
FFC |
AUTRE |
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CADETTES |
15-16 |
18 |
10H00 |
8 |
10 |
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JUNIORS FILLES |
17-18 |
18 |
10H00 |
14 |
15 |
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CADETS |
15-16 |
18 |
10H00 |
8 |
10 |
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JUNIORS |
17-18 |
36 |
11H00 |
14 |
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DAMES |
19 et + |
36 |
11H00 |
14 |
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MASTERS 1 |
30-39 |
36 |
11H00 |
14 |
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MASTERS 2 |
40-49 |
36 |
11H00 |
14 |
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MASTERS 3 |
50 et + |
36 |
11H00 |
14 |
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TANDEMS * |
15 et + |
36 |
11H00 |
2X 10 |
2X 12 |
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OPEN 36 |
17 et + |
36 |
11H00 |
14 |
15 |
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ESPOIRS |
19-22 |
46 |
12H00 |
14 |
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SENIORS |
23-29 |
46 |
12H00 |
14 |
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ELITES |
19 et + |
46 |
12H00 |
Invitι |
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OPEN 46 |
19 et + |
46 |
12H00 |
14 |
14 |
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* |
Joindre 2eme bulletin d'inscription
pour les tandems |
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| Chθque joint obligatoirement ΰ l'ordre de |
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19, Place
Paul Gauguin - 84300 CAVAILLON |
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16h00 Remise des prix - Salle des fκtes de GORDES |
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