Enrollment Form 20 km of Brussels 19.05.2019
Company Name *
Your answer
Participant's Personal Information
Last Name *
Your answer
First Name *
Your answer
Gender *
M = Male ; F = Female
Birthdate *
MM
/
DD
/
YYYY
Nationality *
Please use ISO 3 code: BEL, FRA, NLD, DEU, JPN, USA etc.
Home Address: Street *
Your answer
House Number *
Your answer
City/Town *
Your answer
Postal Code *
Your answer
Country *
Please use ISO 3 code: BEL, FRA, NLD, DEU, JPN, USA etc.
Phone *
Your answer
Emergency Number *
This number must be different from your personal phone number
Your answer
Email Address *
Your answer
Language *
Participant's Running Information
Expected Running Time (h:mm) *
Your answer
Size of the T-shirt *
S = Small ; M = Medium ; L = Large : XL = Extra-Large
Final items
The participation to the 20 km of Brussels is subject to the organisers' conditions, which can be found on

FR : http://www.20kmdebruxelles.be/la-course/reglement/
NL : http://www.20kmdebruxelles.be/nl/de-race/reglement/
GB : http://www.20kmdebruxelles.be/en/the-race/reglement/

and which you need to approve.

Agreement *
Required
Comments
Your answer
Payment
Participants are requested to pay the participation fee of € 60 on UFB's account
BE71 9530 0000 0369, with the mention "20 KM participation + name of runner".

Participation will be confirmed only after receiving payment.

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