First Name* |
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Last Name* |
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Address* |
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Postal / ZIP code* |
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Town / City* |
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Province / State |
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Country* |
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Telephone* |
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Mobile |
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Email* |
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Nationality* |
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Date of Birth* |
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Gender* |
Male
Female
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Tour* |
Full Tour ( Paris-Dakar )
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Section, please specify
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Cyclist / Non-cyclist* |
Cyclist
Non-cyclist
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Shirt size* (Note) |
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