* 28 May 2017 * 'open' LCMT finale * inschrijvingsformulier * formulaire d'inscription *
Max. 400 dag-inschrijvingen (vooraf) - max. 400 inscriptions de jour seront acceptées - there's a limit of 400 day-tickets
Email address *
LCMT, the greatest bike adventure in Benelux, now open to everybody on final day (day-tickets till 21 May or till sold out)
KIES JE AFSTAND - CHOISSISSEZ VOTRE DISTANCE - WHAT DISTANCE YOU WILL BIKE? *
Voornaam - Prénom - First name - Vornahme *
Your answer
Familienaam - Nom de famille - Family Name - Familien Nahme *
Your answer
Adres: straat + nummer - Adresse: rue + n° - Adresse (Strasse und Nummer) - Address (street & number) *
Your answer
Postcode - Code Postal - Postal code - Postnummer *
Your answer
Gemeente - Commune - Gemeinde - City/community *
Your answer
LAND - COUNTRY - PAYS *
E-mail *
Your answer
Geboortejaar (maand/dag/jaar)- Date de naissance - Geburtsjahr - Year of birth *
MM
/
DD
/
YYYY
Bloedgroep - Blood group - Group sanguin - Blutgruppe
Met competitievergunning? - With competition licence? - Avec licence compétition? *
Licentienummer (zo ja) - Votre numéro de licence (si oui) - Your licence number (if you have one)
Your answer
A copy of your responses will be emailed to the address you provided.
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