The Ant Hill Mob

The Ant Hill Mob

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The Ant Hill Mob

The Ant Hill Mob

This information will only be used in case of an accident or emergency. Please take the time to fill this in fully and to the best of your knowledge. By completing it you are agreeing that you are riding at your own risk and responsibility on open, public roads. Traverse Aravis Ltd or anyone acting for them will not take responsibility for any accidents/incidents that may happen.

Personal Information

Name

First Name

Last Name

Mobile Number

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Passport Number

Place of Issue

of Passport

Next of Kin

Name and Telephone Number

Medical Conditons and Dietary Requirements

Please state any medical conditions, allergies or dietary requirements

European Health Insurance Card Information

EHIC Identification Number

It is important to note that this does not replace the requirement for Travel Insurance as it does not cover repatriation or any private emergency care. However, it really helps when admitted to a European Hospital. Please carry this with your ID (drivers license) on you on your bike (write Carte Vitale if you are a french resident)

EHIC Identification Number of Institution

EHIC Identification Number of the card

Insurance Information

Insurance Company Name

It is mandatory that you organise your own travel insurance that provides suitable cover for road cycling. By filling out this form you are agreeing that you will be riding under your full responsibility on open roads. Traverse Aravis Ltd will not take any responsibility for accidents that may occur.

Insurance Contact Number

Insurance Policy Number

Transport Information

Inbound flight no

Inbound Arrival Time

Hour

Minute

Second

Outbound flight no

Outbound Departure Time

Hour

Minute

Second

Tour du Mont Blanc

Tour du Mont Blanc

Tour du Mont Blanc

Tour du Mont Blanc

Personal Details

Name

First Name

Last Name

Mobile Number

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Passport Number

Place of Issue

of Passport

Next of Kin

Name and Telephone Number

Medical Conditons and Dietary Requirements

Please state any medical conditions, allergies or dietary requirements

European Health Insurance Card

EHIC Identification Number

EHIC Identification Number of Institution

EHIC Identification Number of the card

Insurance Details

Insurance Company Name

Insurance Contact Number

Insurance Policy Number

Transport Details

Inbound flight no

Inbound Arrival Time

Hour

Minute

Second

Outbound flight no

Outbound Departure Time

Hour

Minute

Second

Ripcor Alpine Adventure

Ripcor Alpine Adventure

Ripcor Alpine Adventure

Ripcor Alpine Adventure

Personal Information

Name

First Name

Last Name

Mobile Number

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Passport Number

Place of Issue

of Passport

Next of Kin

Name and Telephone Number

Medical Conditons and Dietary Requirements

Please state any medical conditions, allergies or dietary requirements

European Health Insurance Card Information

EHIC Identification Number

EHIC Identification Number of Institution

EHIC Identification Number of the card

Insurance Information

Insurance Company Name

Insurance Contact Number

Insurance Policy Number

Transport

Inbound flight no

Inbound Arrival Time

Hour

Minute

Second

Outbound flight no

Outbound Departure Time

Hour

Minute

Second

Paris Cycling Group June Weekend

Paris Cycling Group June Weekend

Paris Cycling Group June Weekend

Paris Cycling Group June Weekend

Personal Details

Name

First Name

Last Name

Mobile Number

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Next of Kin

Name and Telephone Number

Medical Conditons and Dietary Requirements

Please state any medical conditions, allergies or dietary requirements

Inbound Arrival Time

Hour

Minute

Second

Outbound Departure Time

Hour

Minute

Second

Carte Vitale Number

Insurance Company Name and Policy Number

Insurance Contact Number

Passport Number

High Alps Challenge

The High Alps Challenge

High Alps Challenge

The High Alps Challenge

Personal Details

Name

First Name

Last Name

Mobile Number

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Passport Number

Place of Issue

of Passport

Next of Kin

Name and Telephone Number

Medical Conditons and Dietary Requirements

Please state any medical conditions, allergies or dietary requirements

European Health Insurance Card

EHIC Identification Number

EHIC Identification Number of Institution

EHIC Identification Number of the card

Insurance Details

Insurance Company Name

Insurance Contact Number

Insurance Policy Number

Transport Details

Inbound flight no

Inbound Arrival Time

Hour

Minute

Second

Inbound Arrival Date

YYYY

Outbound flight no

Outbound Departure Time

Hour

Minute

Second

Outbound Departure Date

YYYY

Etape Weekend

Etape Weekend

Etape Weekend

Etape Weekend

Please note that this weekend is run separately from the Etape organisation, therefore, you must ensure that you have arranged entry to the event independently. You must also ensure that you have arranged suitable insurance cover for the weekend. Traverse Aravis Ltd or anyone acting for them will not take responsibility for any accidents/incidents that may happen.

Personal Details

Name

First Name

Last Name

Mobile Number

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Next of Kin

Name and Telephone Number

Medical Conditons and Dietary Requirements

Please state any medical conditions, allergies or dietary requirements

Inbound Arrival Point

Inbound Arrival Time

Hour

Minute

Second

Outbound Departure Point

Outbound Departure Time

Hour

Minute

Second