Registration Form - Grand Prix Cycliste Gatineau

Registration Form / Bulletin d’engagement UCI
Grand Prix Cycliste Gatineau – Chrono Gatineau (UCI WE 1.1)
June 6 & 7 2014 / 6 et 7 juin 2014
Cycling Canada Cyclisme
Name of team / Nom de l’équipe :
_________________________________________________________________________________
Team Representative / Représentant de l’équipe (nom/name + address/ adresse) :
______________________________________________________________________________________________
______________________________________________________________________________________________
______________________________________________________________________________________________
The team hereby enters the following riders:/ L’équipe engage les coureurs suivants :
--------------------------------------------------------------------------------Chrono Gatineau (UCI WE 1.1)
Individual Time Trial June 6, / Contre-la-montre individuel le 6 juin 2014 Maximum 60 riders
Riders /Coureurs
UCI code
Remplaçant/alternates
UCI code
1.
2.
3.
4.
---------------------------------------------------------------------------------G.P. Gatineau (UCI WE 1.1) épreuve sur route en circuit – road race on closed circuit June 7, 2014
Riders /Coureurs
1.
2.
3.
4.
5.
6.
UCI code
Remplaçant/alternates
UCI code
Team / Équipe
Directeur Sportif
Staff / Personnel / Mécanicien
Staff / Personnel / Soigneur
Email address / adresse courriel
In conformity with articles 1.2.049 and 2.2.009 of the UCI rules, the organizer pays the team a participation allowance
amounting to : _______________________________________
The team asserts that it is aware of the sanctions stated by the UCI rules in case it fails to be present and commits to
paying the organizer the amounts set by the article 1.2.053 of the UCI rules by way of damages.
The form shall be duly completed, signed and returned to the organizer in quadruplicate within the deadlines stated by
article 1.2.049 of the UCI rules.
______________________________________________________________________________________________
Date et lieu
Date and place
______________________________________________________________________________________________
Race Director / Directrice de Course
Team representative / représentant d’équipe
Grand Prix Cycliste Gatineau – Chrono Gatineau
214 boul. St-Joseph, Gatineau (Québec), Canada, J8Y 3X7
Télécopieur / fax : 450-227-9124 / [email protected]
Téléphone : 450-227-6714
http://www.grandprixcyclistegatineau.com