MICRO-MOBILITY WINTER GAMES 2020
Micro Mobility Winter Games 2020, Brussels 7-9 February 2020

REGISTRATION TO THE COMPETITION IS VALID ONCE YOU HAVE SUBMITTED THE REGISTRATION FORM BELOW AND PAID THE REGISTRATION FEE TO BELGIUM WHEELERS ASBL.
Name *
Your answer
First name *
Your answer
Date of birth *
MM
/
DD
/
YYYY
Place of birth *
Your answer
Postal address *
Complete address (Street, number, box, zipcode, community)
Your answer
Telephone number *
Please use the international notation: +XX YY YYYYYY
Your answer
Email address *
Your answer
Belgian National Number or Passport Number for non-Belgian inhabitants *
Your answer
Nationality *
Your answer
Emergency Contact *
Please fill out name and mobile number
Your answer
By filling out this form: *
Required
Type of vehicle:
Brand: *
Your answer
Model: *
Your answer
Voltage: *
Your answer
Power (W): *
Your answer
Battery capacity (Wh) *
Your answer
Weight (Kg) *
Your answer
Electric unicycle
If a device qualifies for 2 categories based on voltage and power, the voltage takes precedence and determines the category.
Electric Step
Electric Skate
Onewheel
During the competition, I accept the following conditions: *
Required
Insurance: I accept the following: *
Required
I commit to paying the following registration fee: *
The payment must be done by bank transfer to the BELGIUM WHEELERS account (IBAN BE41 7350 5271 2010 - BIC : KREDBEBB), with the following reference: FAMILY NAME FIRST NAME MMWG 2020
I accept the following: *
Required
I confirm/declare: *
Required
In order to comply with the "GDPR", I expressly agree to receive emails from BELGIUM WHEELERS ASBL by checking the "I accept" box below: *
GDPR legislation on personal data - I declare that I have been informed and accept that: a. All of my personal data (names, addresses, telephones, e-mail, national register number and VAT) constitutes a "member file" which is the exclusive property of BELGIUM WHEELERS ASBL; b. BELGIUM WHEELERS ASBL will keep this personal data private, with care, for the purposes of registration and / or participation in our activities; c. BELGIUM WHEELERS ASBL will only use this data for the purposes necessary for its proper functioning (registration, insurance, invoicing, delivery, contact persons, etc.); d. BELGIUM WHEELERS ASBL will only communicate this data to third parties with my express consent, and only for purposes determined by the needs of the organization of activities and the smooth running of them, in accordance with the General Data Protection Regulations ("GDPR"); e. My email address will be used regularly for the communication of information specific to BELGIUM WHEELERS ASBL: activities, changes within the ASBL, news and monthly and / or exceptional offers; f. At any time, I can ask to be removed from the BELGIUM WHEELERS ASBL database or to no longer receive emails from the ASBL; this request must be sent to BELGIUM WHEELERS ASBL by e-mail or letter; g. I can also exercise my right of access to my personal data, request to know the information available to BELGIUM WHEELERS ASBL, and if necessary request the modification of these data.
Required
Date and signature *
Date and full name of the participant, preceded by "Read and approved".
Your answer
FOR PARENTS OF MINORS PARTICIPATING IN THE COMPETITION
Copy this text to the Response field and fill out the names: I undersigned ……………………………………………………authorise my child ……………………………………………………………… to take part in the MMWG 2020 competition. I have ensured that s/he is covered by the necessary insurance policies for the child and the vehicle that s/he will be using.
Your answer
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