Registration

Updated May 12, 2008
 

 

Next Défi:
Saturday, October 18, 2008

 
 
FAMILY NAME:__________________________ FIRST NAME:_______________________

ADDRESS:_________________________________________________________________

CITY:_________________________________ PROV/STATE:_______________________

COUNTRY:______________________________ POSTAL CODE:______________________

TEL:________________________________ FAX:________________________________

EMAIL:______________________________ DATE OF BIRTH:______________________

T-SHIRT SIZE:_____(Medium) _____(Large) _____(X-large)


SIGNATURE:_______________________________________________________________
(MUST be signed by you, or by your parent/guardian if you are under 18.)
"I hereby for myself, my heirs, executors or anyone else who might claim 
on my behalf, covenant not to sue or to claim damages against the Défi de 
L'Île de Montréal or any of its organizers or sponsors."


REGISTRATION: _____$45.00 (before Sept. 15, 2008)
              _____$50.00 (after Sept. 15, or 4:30-5:45 am on race day)

 

Send with check or money order payable to:

 
Le Défi De L'Île De Montréal
3196 boul. Lasalle
Verdun, QC  H4G 1Y9
Canada

 

Tel: (514) 768-1587   Fax: (514) 768-5522

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