Défi de L'Île de Montréal128 km on inline skates |
FAMILY NAME:__________________________ FIRST NAME:_______________________
ADDRESS:_________________________________________________________________
CITY:_________________________________ PROV/STATE:_______________________
COUNTRY:______________________________ POSTAL CODE:______________________
DATE OF BIRTH:________________________
TEL:__________________________________ CELL:_____________________________
EMAIL:___________________________________________________________________
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: _____$55.00 (before October 1, 2010)
_____$60.00 (after October 1, or 4:30-5:45 am on race day)
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| Le Défi De L'Île De Montréal 3196 boul. Lasalle Verdun, QC H4G 1Y9 Canada |