Entry Form (print out, fill in, sign and send to address at bottom)
Polaris Challenge France
First Member of the Team
Name_________________________ First name_____________________
Sex M / F date of birth _____________________
address________________________________________________________
______________________________________________________________
tél._________________________ e-mail____________________________
Second Member of Team
Name_________________________ First name _______________________
Sex M / F date of birth_____________________
address _________________________________________________________
________________________________________________________________
tel._____________________ e-mail____________________________________
Category of team entry _______________________________________see chart,
CATÉGORIES AND TARIFS :
Please circle your team's category (the addition of both members ages)
|
Addition of ages of both members
|
MALES
|
FEMALES
|
MIXED
|
|
34 - 40
|
junior
|
junior
|
adulte + junior
|
|
41 - 80
|
senior
|
senior
|
senior
|
|
81 - 100
|
veteran
|
veteran
|
veteran
|
|
100+
|
super veteran
|
super veteran
|
super veteran
|
Entry fee per team = 100 euros
Map of area IGN at 1:25000: Price : 12 euros x ___ = _____euros
TOTAL = euros
Cheque payable to M.J.Wilcock
I have read and accept the rules
signature of each team member
Send entry-form with cheque to
Polaris challenge,
La Tour
09290 Camarade
Ariege France
|