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SOLICITA TU DORSAL
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Nombre
*
Your answer
1º Apellido
*
Your answer
2º Apellido
*
Your answer
DNI
*
Your answer
Fecha de nacimiento
*
DD/MM/AAAA
Your answer
Movil
*
Your answer
Email
*
Your answer
Repetir Email
*
Your answer
Procedencia
*
Gran Canaria
Tenerife
Fuerteventura
Lanzarote
La Palma
El Hierro
La Gomera
Other:
Código postal
*
Your answer
Alergias
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Mariscos
Glucosa
Penicilina
Ácaros
Ácido Acetil Salicilico
NINGUNA
Other:
Deficiencia o enfermedad
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Diabetes Tipo 1
Diabetes Tipo 2
Hipertension
Baja visión
NINGUNA
Other:
Operaciones, lesión leve, crónica.
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Menisco
Cervicales
NINGUNA
Other:
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