- Registration

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I want to register for?


Your Name and Last name: (*)


Your email: (*)


Phone number: (*)


Address : (*)


ZIP Code: (*)


City/State and Country: (*)


Birth Date:
/ /  

Passport number or D.N.I.:


Medical Insurance:


Medical Insurance Phone (and # if necessary):


T-shirt size:


Please list below any medical or physical condition(s) that should be noted by the Medical Director. Please describe any medical/physical conditions that may affect your ability to safely take part in this event and list any medications that you are routinely taking. Also please mention if you are allergic to any insects, or medicines. List N/A if no conditions exist.










The Other Team Member Information.


Your Name and Last name:


Your email:


Phone number:


Address :


ZIP Code:


City/State and Country:


Birth Date:
/ /  

Passport number or D.N.I.:


Medical Insurance:


Medical Insurance Phone (and # if necessary):


T-shirt size:


Please list below any medical or physical condition(s) that should be noted by the Medical Director. Please describe any medical/physical conditions that may affect your ability to safely take part in this event and list any medications that you are routinely taking. Also please mention if you are allergic to any insects, or medicines. List N/A if no conditions exist.









WAIVER:
I hereby confirm that I have read the Q50 Ultramarathon Rules and Regulations and voluntarily sign this waiver. I confirm my agreement to assume the entire risk of any loss, property damage, illness, injury, contact with other participants, damages caused by weather conditions and geographical obstacles, or death that I may sustain or cause as a result of my participation on the Q50 Ultramarathon (the “Event”). I understand that my participation in the Event may include participation in activities which demand a very high level of skill and physical and mental fitness. I confirm that I register on the Event declaring to be medically able and properly trained. I hereby assume responsibility to follow any decision given by an organization official or doctor relative to my ability to complete the race. Having read this text and having acknowledged possible consequences and considering my acceptance in participating in the Event, I hereby, under my name and under any person that may represent me, release and discharge Q50 Ultras Organizers, local authorities related to the event and all Oficial Sponsors that intervene in the Event, contractors, representatives and successors, from present and future claims and liabilities of any kind, known or unknown, arising out of my participation on this event or related activities, even though such claim or liability may arise out of negligence or fault on the part of any of the forgoing persons or entities. I grant permission to the foregoing persons or entities to use any photographs, motion pictures, recordings, or any other record of my participation in this event for any legitimate purpose without remuneration.


© Q50 RACES :: sitio actualizado: Viernes, 25 de Julio 2014 :: Diseño Web: Creativa