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To Walk Again
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Results 2004
TAKE UP THE CHALLENGE AND REGISTER QUICKLY.
Participation fee is 35 euro.
Registration form
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Personal information
Name
!
First name
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Street
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N°
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Box
Zipcode
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Location
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Country
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Day of Birth
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E-mail
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Telephone
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Fax
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Mobile
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Gender
Male
Female
Club name
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Licence n°
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I certify to be in good health
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Race information
Marc Herremans Classic
»
S
M
L
XL
XXL
!
ChampionChip Code:
Buy ChampionChip
Rent ChampionChip
!
35 €
30 €
3 €
TOTAL
Modes of payment
Money order from account n°
!
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to N° 330-0675280-20 of BRRC (IBAN: BE28 3300 6752 8020 - SWIFT: BBRUBEBB)
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Cardnumber:
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Licensee:
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Expiry Date:
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"All information is intended for use by octagon cis only. However, information can be passed on to the parties that are bound to octagon cis by contract. The law of 8 December 1992 (concerning the protection of the personal integrity with regards to data processing) lays out the access of the data and improving it. By your participation in the event you agree with the possible use by octagon cis of your photograph in a.o. print, film, video for promotional purposes of octagon cis, without claiming compensation for the actual use."
