"In case of participating in the mixed relay cathegory, fill up this form per participant with the name of your team"
Name: Stature:
City: Address:
Zip code Telephone
number
Celular: State;
Sex: Woman Man Country:
Peso: E-Mail:
Age: Category:

Team name:
*Only for the relay Mixed cathegory
The members of the team may be:
2 Men and one woman or
2 women and a man.

     
I practice bici of route (days per week):

1 day per week
2
3
4
  I run:

5Km
10Km
20Km
+ 20 Km
     
I practice swimming to the week:

1 km
5 kms
+ 5 kms.
  I have competed in:

     

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