OFFICIAL ENROLMENT FORM

Event:            Open de Suéde Road Race                                                  Class : CDM

Date:             31 / 7 / 2011

Organiser:      Vårgårda Cykelklubb, Box 55, S-447 22 Vårgarda, Sweden

                  e-mail: info@worldcupvargarda.se Contact: Helen Henriksson +46702685341

National Federation authorising the event:                     Swedish Cycling Federation

Number of riders per UCI Women’s Team / national team:  6

Name of UCI Women’s Team / National team:

Represented by: 

            e-mail:   Tel: 

hereby enters the following riders for the above-mentioned event :

TITULAR RIDERS

NAME                             First name                    uci code

1.

2.

3.

4.

5.

6.

REPLACEMENT RIDERS (maximum 50% of the number of titular riders)

NAme                            First name                    uci code

1.

2.

3.

The UCI Women’s team / National team will be managed by:

PARTICIPATION ALLOWANCE

The organizer's contribution to participation allowance is as follows, according to article 2.2.009 of UCI regulations:       Full board and lodging for 6 riders + 3 staff for two days.

COMPENSATION OF ORGANISER

Should a national team / UCI Women’s Team fail to be present, the undersigned person, on behalf of that national team / UCI women’s team, undertakes to pay the organiser the sum provided in article 1.2.053 of UCI regulations, for his own benefit and by way of damages.

This form shall be duly completed and signed and returned to the organiser in quadruplicate at least 20 days before the event.

Place and date:

Organiser’s signature                                   Signature of the UCI women’s team / National team

                                              Union Cycliste Internationale – CH-1860 Aigle

                                          Tél. +41 24 468 58 11 – Fax +41 24 468 58 12