Individual registration form,
fill every part of the form
Gran Fondo Internazionale FELICE
GIMONDI
c/o G.M.Sport -Via
G. Da Campione, 24/B - 24124 BERGAMO - Italy
Ph . +39.035.211721 - Fax +39.035.4227971
Please attach copy of the
payment of the entry fee. Read carefully the terms of Registration, then
fill the Entry Form.
Surname
Name
Gender M
F
Date
of birth
Address
Post
Code
Town
Country
Profession
Phone
Mobile
Ph.
Cycling
Team
Cycling
Team Code
Cycling Team is a member of the Board:
Cyclist’s
Card No.
E-Mail
Cyclist’s Card No.
If you do not have the chip, you can hire at the
venue.
REGISTRATION
FEES
Euro 27,00+Euro 10,00 (for the deposit of the TDS Chip which will be reimbursed at the end of the race when returning the Chip)
Euro 85,00+Euro 10,00 - includes the items listed above plus the commemorative jersey in wool, short sleeve, short zip, exclusive design, “Gran Premio delle Nazioni 1967”, the thirteenth of the series "FELICE GIMONDI", to book through the registration form.
M
L
XL
XXL
METHOD
OF PAYMENT
Cash,
directly to the
Organising Committee: G.M.S. Via G. Da Campione, 24/b
- 24124 Bergamo-Italy
To G.M.S. Bank transfer into account number Iban
IT35-Bic Crebit 35 Largo Porta Nuova - 24122 Bergamo-Italy
P.O. Giro Transfer to a/c number 23263270
G.M.S.
Via G. Da Campione, 24/b - 24124 Bergamo-Italy
ATTENTION: I
state to know and to respect the regulations of the Event and the F.C.I.
rules, and to be of age before the date of the Gran Fondo Internazionale
Felice Gimondi. I know that I am not allowed to take part into the event
if I am not physically qualified and suitably prepared. I submit my registration
voluntarily and I undertake all the risks connected to my participation
in the race, as falls, crashes with other cyclists, cars, spectators etc.,
and including cases of bad weather conditions or cold temperature, traffic
and conditions of the road. Knowing what stated above and considering
the acceptance of my registration, I voluntarily free the Organising Committee
, the G.M. Sport, the promotion authorities and all the sponsors from
all the present and future complaints or responsibilities, known or unknown,
deriving from my participation in the Event. I authorize the Organising
Committee to use pictures, recorded images, videos and any sort of element
relative to my participation in the event for every legal use, and without
receiving any recompense. Personal data will be treated in accordance
with Legge n.196 del 30.06.2003 (Italian Privacy Act), and I will have
access to my personal data in any moment, asking for their modification
or elimination, or I can oppose to their use writing to the Organising
Committee.
