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Name* First name *

Adress*

Country*

Tel number* Fax  Email*

A password if you want to modify your file *

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Glider : brand  * / type / colour

Special peculiarities on your glider    

Social security number    blood group   

Allergies and medical peculiarities  :

Person to be called in case of accident  :

Will you have a mobile during the competition ? #

G.P.S. model ?

Would you like to be a candidate to the pilots committee ? YES / NO

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Press information :

your sports classifications:

your best results in competition :

your PWC national ranking this year :

Payment : your registration will be effective as soon as we receive your payment.

You’ll be charged 120€ for registration before October 15th, 2010, 140€ after this date.

• Send a cheque payable to LVLR to:
  LVLR
  c/o Pascal DELATTRE
  36 allée Lataniers
  97424 LE PITON SAINT LEU

• Or make a bank transfer to :
  Thank you ask for the codes IBAN in
  pascal.delattre@mediaserv.net