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****************        PATAGONIA EXPEDITION RACE            ***************

****************   					     ***************

****************        REGISTRATION FORM PER2009            ***************

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!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

!!!!   INSTRUCTIONS: 							   !

!!!!									   !

!!!!   Save this file to disk.						   !

!!!!   Only registration forms which have been filled in with all the	   !

!!!!   information for at least two members of the team, one of which	   !

!!!!   must  be  the  captain,  will  be  received.  The  information 	   !

!!!!   regarding  remaining  members  of  the  team must be sent soon 	   !

!!!!   thereafter.							   !

!!!!   									   !

!!!!   Send as attachment to info@patagoniaexpeditionrace.com	 	   !

!!!!									   !

!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!!

				

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Team name:	

			

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Why you want to participate in this race?:	







			

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Team member #1  /  Captain  ************************************************

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First name:



Last name:



Gender: 



Date of birth: 



Passport number: 



Nationality: 



Profession: 



e-mail: 



Address: 



Phone: 



Fax: 



Sporting history: 







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Team member #2		   *************************************************

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First name:



Last name:



Gender: 



Date of birth: 



Passport number: 



Nationality: 



Profession: 



e-mail: 



Address: 



Phone: 



Fax: 



Sporting history: 







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Team member #3		   *************************************************

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First name:



Last name:



Gender: 



Date of birth: 



Passport number: 



Nationality: 



Profession: 



e-mail: 



Address: 



Phone: 



Fax: 



Sporting history: 







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Team member #4		   *************************************************

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First name:



Last name:



Gender: 



Date of birth: 



Passport number: 



Nationality: 



Profession: 



e-mail: 



Address: 



Phone: 



Fax: 



Sporting history: 







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