Application form

TRIATHLON swim 1,9km –bike 90km- run 21km *

TRIATHLON SPRINT swim0,6km- bike 15km- run 3km *

TAQATHLON swim 0,4- run2km *

Information

First name*

Surname*

Date of birth

Day

Month

Year

Male/Female*

Finisher shift*

ADDRESS:

Street*

Number*

Nr mieszkania

Zip code*

Zip code* :: Format XX-XXX

City*

Representing country*

Phone

Email*

Club:

Club

Sponsor

I agree to disclaimer and indemnification clause. I have read and accepted the rules

HERBALIFE
TRIATHLON SUSZ 2010
Centrum Sportu i Rekreacji
w Suszu (Hala Sportowa)
ul. Piastowska 5c

tel. (+48) 604 916 501
biuro@susz-triathlon.pl

Informacje:
Piotr Netter
tel.: +48 604 916 501

Promocja:
Piotr Jakóbik
tel.: +48 511 291 080

Sponsoring:
Michał Drelich
tel.: +48 510 175 462