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Application Form
Event: Dorians Coastal Challenge
Date: Saturday, 4 May 2019
Venue: Limassol Molos
Arrival time at Venue: 07:00
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Name: *
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Surname: *
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E-mail Address *
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Date of Birth: *
Gender: *
Telephone: *
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Full Address (Street Number, Address and Post Code) *
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City: *
T-shirt Size: *
Do you have any health problems? *
If you do not have any health problems, please write NO at the box below. If you have any health problems such as diabetes, asthma, etc. or disabilities, please provide as many information as possible below. We will only use this information in the event of a medical emergency which leaves you unable to speak to medical professionals. It is very important that you fully disclose all information.
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Emergency contact name and surname: *
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Emergency contact telephone: *
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Electronic Signature (Full name and surname): *
By signing below, I certify that all the information I have provided here is accurate and true. I also verify that I have read, understood and accept the terms and conditions, the privacy policy and the Dorians Coastal Challenge Volunteer Waiver Agreement.
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