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*Required information.
Team name *

Team Leader data:

Name *
Surname *
Gender *
Birth place *
Birth date *
City *
Address *
Country *
Phone *
E-mail *
Wetsuit *
T-shirt size *
Attach medical certificate

or send it to losevents2015@gmail.com within 07/07/2019.
 
Download medical certificate >>


Data second athlete:

Name *
Surname *
Gender *
Birth place *
Birth date *
City *
Address *
Country *
Phone *
E-mail *
T-shirt Size *
Attach medical certificate

or send it to losevents2015@gmail.com within 07/07/2019.
 
Download medical certificate >>


Data third athlete:

Name
Surname
Gender
Birth place
Birth date
City
Address
Country
Phone
E-mail
T-shirt size
Attach medical certificate

or send it to losevents2015@gmail.com within 07/07/2019.
 
Download medical certificate >>


Boat support *
Assistants *

Dati persona su barca assistenza / Responsible on the boat:

Name
Phone

I have read and i accept the regulation *
I have read and i accept the disclaimer of liability *

Download disclaimer

I have read and i accept the disclaimer of liability minors

Download disclaimer minors


Payment *