19ème Euro P N - Go East ! BANDURAPEST

 

APPLICATION FORM FOR L’EUROPÉENNE 2018

(Registration automatically includes membership of L’Amicale Euro Cyclotourisme)

 

 

Surname : …………………………………  Forename: …………………………..

 

Nationality: ………………………

 

Address: ……………………………………………………………………………..

 

…………………………………………………………………………… Postcode: ……………

 

Email: …………………………………………. @……………………………………………

 

Landline: ………………………………………  Mobile: ………………………………………….

 

Date of Birth; ……../……../…………  Place of Birth: ………………………………

 

Cycling Club: …………………………………………

 

Size for cycle clothing - info at http://www.vetements-cyclisme.fr/index-2.html

 

(S, M, L, XL, XXL, or XXXL)  : ……………………… Size for T-shirt : (S, M, L, XL, XXL)   : ………………….

 

Are you happy for your contact details to be circulated to other participants?   YES     NO

Price:  1.150 euros

Cashing of cheques: the first (350€) on receipt of application form, then 8 of 100€ which will be cashed on 1st of each month January-August 2018.

Payments from outside France by direct transfer, please.

 

                                                         Signed ………………………………. Date ……………………..

 

Registrations are only acceptable on this form, signed and accompanied by a deposit and a photocopy of your passport or driving licence.

 

To be sent to:                         Alain CHALLANT,

sidence Odyssée Bat A

71 Avenue Jérôme MASSIER

06220 VALLAURIS

France

Email : europn@ffct.org                   Tél : +336 33 71 28 74

 

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