Registration for the "InterFaith - Marathon" in Luxembourg on 19 May 2012

Surname: First name:

Date of birth (DD.MM.YYYY)

Religion:   Gender:     m f

Street and number:

Postcode: Location:

Country: Nationality:

Telephone: Mobile: Email:

Participation in:
Marathon:      Half-Marathon     Relay Marathon (legs from 8.3 to 13.3 km)

Expected time: 

Date of arrival: Date of departure:

Championchip no (if you have already a chip):

Size of T-Shirt:     S M L XL XXL

Remarks:

I will transfer the amount of 44,- € (marathon), 29,- € (half-marathon), 26,- € (relay marathon) to the account of "Evangelische Gemeinde deutscher Sprache in Luxemburg"

IBAN: LU35 0081 6900 4300 1003
BIC :   BLUXLULL
Reference "InterFaith-Marathon 2012".

Registrations will be accepted until 20 April 2012