29/04/07> 06/05/07
www.raid-montpellier-valencia.com


REGISTRATION

To register two solutions :
- print this form and send it with your payment by cheque or postal cheque
(drawn on a post office account) to the following address :

RAID AVENTURA MEDITERRANEE
45 av Jacques Cartier
Résidence Arpèges
34000 MONTPELLIER
FRANCE

- fill in the form below and send your payment by cheque or postal cheque
to the above address.

Registration will be valid as soon as we received your payment, and we will confirm it by e-mail.

REGISTRATION FEES : 500 km ; 250 km : 800 euros payable in 3 instalments
before the 15th of April 2007
Payment by cheque or credit transfer to the order of RAID AVENTURA
MEDITERRANEE
Closing registration date : March 30th 2007 . The raid is limited to 50
competitors.

CANCELLATION FEES
50 euros deducted in case of withdrawal before March 31st 2007
10% of the total commitment fees will be deducted in case of withdrawal
between 30/11/2006 and 31/01/2007
25% of the total commitment fees will be deducted in case of withdrawal
between 01/02/2007 and 28/02/2007
After February 28th 2007 no claim will be accepted.

I, the undersigned, certify that I have been fully informed of th regulation
of the 5th raid Montpellier- Valencia organized by RAID AVENTURA
MEDITERRANEE and that I have fully accepted the terms without reservation.

I declare that I will take part in the 5th raid MONTPELLIER-VALENCIA with
full knowledge of the potential risks of the competition.

In order to be registered for good , the totality of the fees will have to
be paid on April 15th 2007 at the latest.

On the other end, during administrative and technical controls I will
present the medical certificate of aptitude for the 5th Raid
MONTPELLIER-VALENCIA as well as an elecrocardiogram dated a month before the
departure date of the race.

I make a sworn statement of the exactitude of all information written down.
INFORMATIONS FORM
All the fields must be completed

Name :
First name :
Address 1 :
Address 2 :
Zip code :
City :
Country :
Email :
phone. :
Fax :
Age :
Nationality :
Né(e) le :
À :
Passport N° :
Delivered the :
(Country) :
Further information
Family situation :
Profession :
Phone. Work :
Fax :
Weight (kg) :
Size :
Blood group :
In case of emergency, nobody To prevent
FORM OF COMMITMENT

I, the undersigned, certify that I have been fully informed of th regulation of the 5th raid Montpellier- Valencia organized by RAID AVENTURA MEDITERRANEE and that I have fully accepted the terms without reservation.

I declare that I will take part in the 5th raid MONTPELLIER-VALENCIA with
full knowledge of the potential risks of the competition.

In order to be registered for good , the totality of the fees will have to
be paid on April 15th 2007 at the latest.

On the other end, during administrative and technical controls I will
present the medical certificate of aptitude for the 5th Raid
MONTPELLIER-VALENCIA as well as an elecrocardiogram dated a month before the
departure date of the race.

I make a sworn statement of the exactitude of all information written down.
City :
Date :
Signature :
-

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