REGISTRATION FORM

Fill in all parts and mark the items chosen.

Name                     Surname

Street                            Zip code

Town/City                    Province

Telephone                             Fax

Birthdate                 Profession

Identity card or driving licence n° (specificy)

Racing licence    YES       NO            Tax code, if applicable

Mountain Bike or motorcycle owned Displacement: cc

Use of school bike      YES      NO                                              Use of school motorbike      YES         NO 

 Reason for participation:   Initiation Improvement Athletic course Holiday                   Difficulty of the motormountaineering itinerary  Low (Beginners) Medium High (Advanced)

Course: Trial course Motormountaineering Mountain Bike BMT            Special courses (please specify)   

Further request as per brochure:

Period chosen:

Total price of the course chosen:                   Discount (if any):

Signature (attach authorization for minors):

Note: This registration is valid only after the return of the form with stamp and signature of approval by the Valsesia Trial School,  on condition that there is a minimum of 5 participants per course (only for complete courses). If the school fixes a different date from the one chosen by the participant and this one gives up (up to 3 days prior to the date), the entire deposit fee (100%) will be returned.

Do not write anything more after this point.                                                                                                                                                                              

Approval with stamp and signature:

Period agreed: