(please read the rules before applying)
Name:
Firstname:
Address:
ZIP / City:
E-mail:
Mobile:
Date of Birth:
Nationality:
shirt Size: S M L XL
I am a vegetarian: yes no
To know you better, your past runs ....
Accommodation required during the weekend:
| Camping / tent | free | |
| Community hall | free | |
| place for Camping Car / caravan | € 15 | |
| Accommodation in a cottage in the camping (no facilities) | Rate (to come) | |
| Accommodation in a cottage in the camping (with toilets) | Rate (to come) | |
| Lodging / Hotel * (at your expense) | organization can take care of hotel booking |
Meals: Meals runnes are included in the registration fee
Number of non-running people for 2 meals (on Friday and Sunday evening) : ....
Registration fee : € 110 (payable to the "Ultr Ardèche ")
Non runner meal: .. x € 35 = ....
= Total ............. €
I will come by train and will use the shuttle provided by the organisation
Day and projected arrival time (to be confirmed 15 days before the start of the event): ......
I accept the rules and am aware that participation in the Ultr'Ardèche under my sole responsibility
Date and Signature
Laurent BRUEYRE
380 Allée belle vue
07130 SOYONS
France
