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Formulaire Pré-inscription Trail des Croix 2017
Nom / Naam / Name: *
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Prenom / Vooraam / Vorname: *
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Date de naissance / Gebortedatum / Birthdate: *
jj/mm/aaaa
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Sexe / Sex: *
M / F
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Adresse / Adress:
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Code postal:
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Ville / Stad / Town:
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Pays / Land:
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Téléphone / Telephoon / Phone:
exemple: +32 80 11 22 33
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GSM *
exemple: +32 499 11 22 33
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Email: *
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Distance *
Club
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