Registration form IKSA footbike eurocup 2016 - Netherlands
Location Pasta Party Friday = Hengelo races saturday = Losser and sunday = Oldenzaal (Twente region Netherlands)
May Fri. 20, Sa. 21 & Su. 22, 2013 | vrij. 20, za. 21en zo. 22 mei 2016.
Name / Voornaam *
Your answer
Surname / Achternaam *
Your answer
Geslacht *
Date of birth / Geboortedatum *
Your answer
City / Woonplaats *
Your answer
Nationality / Nationaliteit *
Your answer
Footbiketeam / Stepteam *
Fill out the correct team name of your local or commercial team to receive eurocup points (NO national team names please).
Your answer
Mobile Phone / Mobiel
Your answer
E-mail *
We use this for confirmation (so no E-mail = no confirmation)
Your answer
Competitor, Accompany or helper (Deelnemer, begeleider of helper) *
Diner [day 2]
I take part in / Ik neem deel aan
Registration - (3 riders) Teams for Team Pursuit (team race)
Fill out the names of 3 riders and your team name! (vul de namen in van 3 rijders en uw teamnaam)
Your answer
Chiptiming: *
(borrowing a chip during the weekend is free for the first chip (It is possible to rent an extra chip (€ 5,-} appointed to 1 rider in case of spare footbike). / NED: Bij eurocups is een huurchip gratis .
I have own AMB pro or flex [ not NAF registrated ] transponder CHIP
Fill out CORRECT chipnumber (otherwise timing will not work). In case of orange AMB flex chip make sure it is activitated for this season. If you wanne buy you own AMB pro or flex chip take a look at
Your answer
[OPTIONAL] - Reserve a place in the dormitory
Sleeping place in a dormitory € 10,- per night. There are only a few places available.
(For Dutch) Voor Nederlanders:
Remarks / Opmerkingen
Your answer
[ OPTIONAL ] I volunteer as CREW MEMBER / Ik meld me aan als HELPER
Mark the functions / Vink de functie aan en geef aan in het operkingenvak 29 of 30 juni (of beide)
Eventuele opmerkingen
Your answer
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