ITAENGDEU
Tiliment Marathon Bike
Registration for the race:
Personal details:   UCI Code:
Last name: *   Category:
First name: *   Card number: *
 
Sex: * M F   Ente:
Date of birth: *   Name of Society: *
      Society Code: *
Indirizzo        
Street/Road: * N.   Details  
City: *   Phone n.. **
Province: ZIP:   Mobile n. **
Country: *   Email: *
 
   Yes, I order a Froggy Line bike jersey with "Tiliment Marathon Bike" Design for Euro 40.00
  Size: XS   S   M   L   XL   XXL  

    

 
* Mandatory fields
** At least one field is mandatory

MEMBERSHIP FEE

35 euro for 102,3 km opened to women, under 23, elite, master 1,2,3,4,5, master sport and master sport women

25 euro for 51,3 km opened to women, under 23, elite, master 1,2,3,4,5, master sport, master sport women, junior and junior women

9 euro for 25,6 km not agonistic, opened to everyone

20 euro bail for microchip

Please fax your enrolment together with the receipt for payment to the following number +39 0427.928081 by April 06 at 19.00. You can also enrol to the race, on-line, until April 14 or directly on Saturday, directly on Saturday, April 16, at pre-established time, with an extra cost of 5 euro. The use of the enrolment form, filled on all sides and available on the web site, is compulsory. 
Incomplete enrolment or non-payment will not be valid.

The membership fee payment can be made by bank transfer to A.S.D. Polisportiva Trivium:

IBAN CODE  IT06 Y 0880565030 013000004806
BIC CODE ICRAITRRMD (for non-EU citizen)

All the Tiliment Marathon Bike competitors (51,3 and 102,3km races) will enter in the prize draw for an exclusive Polar Heart Rate Monitor