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3rd RE/MAX Langenlois Cycling Days, June 08-10, 2012

With this enrollment form, you will submit your binding participation in the 3rd RE/MAX Langenlois Cycling Days from June 8 to 10, 2012. With enrollments after May 21, 2012, the enrollment fee shall be paid in cash when picking up the start number.

Individual rider enrollment                                                               Team enrollment

* First name
* Last name
* Year of birth
Sex female
* Nationality
* ZIP
* City
* Street
Phone
* E-mail
* Name of the club
* UCI code
Please tick your stage(s)
Friday, June 8, 2012 (lap race)
Saturday, June 9, 2012 (hill race)
Saturday, June 9, 2012 (time trial)
Sunday, June 10, 2012 (lap race)
* Please tick your category:
Elite Women
Juniors
* Mandatory fields
URC Langenlois | Günther Kanzler
Phone: +43 (0)664 432 95 63 | E-mail: guenther.kanzler@utanet.at