Inscription

20 km de Bruxelles
31.05.2020 | Parc du Cinquantenaire | Bruxelles

1. Nom : *This question is required.

2. Prénom : *This question is required.

3. Matricule FNRS :

4. Université/Institution : *This question is required.

5. Mandat/Poste : *This question is required.

6. Date de naissance (JJ/MM/AAAA) : *This question is required. This question requires a valid date format of DD/MM/YYYY.

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7. Nationalité : *This question is required.

8. Pays de résidence : *This question is required.

9. Code postal : *This question is required. This question requires a valid number format.

10. Localité *This question is required.

11. Numéro de téléphone : *This question is required.

12. Adresse e-mail : *This question is required. This question requires a valid email address.

13. Chrono précédent - Dernier chrono aux 20 km de Bruxelles - Estimation :

14. Sexe : *This question is required.

15. Taille de t-shirt souhaitée *This question is required.