To Be Addressed To: Les Gendarmes Et Les Voleurs De Temps

I N D I V I D U A L R E G I S T R A T I O N F O R M

To be addressed to: Les Gendarmes et les Voleurs de Temps Gaia – Maison des Sports – 142 avenue Emile Labussière – 87100 LIMOGES – FRANCE ( 3 3 ) 0 5. 8 7 . 2 1 . 3 1 . 8 6

Last name: ------First name: ------

Address: ------Postal code: ------Town/City: ------

Country: ------Gender:  M  F Birth date:    Tel. no. (home or mobile): ------Email : ------

 Individual registration  FFA team License number------

If team, please give the name: ------

 I do not want my personal information to be used for other purposes than “Les Gendarmes et les Voleurs de Temps”

RACES REGISTRATION PERIODS PRICE CANCELLATION From 3 October 2016 to 30 January 2017 32€ 5.90€ Trail “Les Voleurs de Temps” From 31 January 2017 to 30 March 2017 40€ 5.90€ 32km From 31 March 2017 to 17 May 2017 50€ 7.90€ From 3 October 2016 to 30 January 2017 58€ 7.90€ Grand Trail du Limousin 58km From 31 January 2017 to 30 March 2017 65€ 7.90€ From 31 March 2017 to 17 May 2017 75€ 7.90€ From 3 October 2016 to 30 January 2017 20€ 5.90€ “Trail des Hureaux 20km From 31 January 2017 to 30 March 2017 25€ 5.90e From 31 March 2017 to 17 May 2017 30€ 5.90€ From 3 October 2016 to 30 January 2017 15€ 5.90€ Discovery Trail 10km From 31 January 2017 to 30 March 2017 18€ 5.90€ From 31 March 2017 to 17 May 2017 22€ 5.90€ Ladies event “Les Voleuses de From 3 October 2016 to 17 May 2017 10€ /// Temps” 5km

Hiking events 10km and 15km From 3 October 2016 to 17 May 2017 5€ ///

Children’s race From 3 Octobre 2016 to 17 may 2017 FREE ///

Pasta Party (limited to 600). 15€ Meal with music band From 3 October 2016 to 17 May 2017 /// Cafeteria Cora

 I enclose a photocopy of my license   I enclose a medical certificate which states expressly the approval of the practice of athletic or running competitions and which is valid at the date of the event 