Application form (please fill in all *fields):

*First and last name
Cycling club
*Date of birth
DD/MM/YY
*Address
*Town/City
*Post code
*Country
*Telephone number
Fax
*E-mail


*Category
Elite Women Master 1
Master 2 Master 3 U-23
Sport 1 Sport 2 Hobby-Tourist
Juniors

*LICENCE
UCI License
UDACE License
Without licence





Accommodation request
Double room single use Double
room
Apartment 3pax
Number of persons
Arrival
Departure
Please indicate the names of the persons who will stay in the room/apartment.

Questions and comments

2/09 3/09 4/09
23°C
17°C
24°C
19°C
24°C
18°C