RacingThePlanet: The 20-Year Race (Jordan 2024) - Medical Information & Emergency Contacts

EMERGENCY CONTACT & MEDICAL FORM

RacingThePlanet: 20-Year Race in Jordan
You must answer the questions in this form accurately. It will be shared with our Medical Director to review before the race.

Based on the information provided in this form, we may request additional information or deny your participation in the event.

If we do not receive this form with adequate advance notice, you may not be allowed to participate.

DEADLINE FOR SUMBITTING: 1 August 2024

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Personal Details
Name (as shown on your Passport)*

First NameLast Name
Email (same as you Race Registration)*
example@example.com
Race Role*
Nationality*
Country of Residence*
Address*

Street Address

Street Address Line 2

CityState / Province / County

Postal / Zip Code
Phone Number (Inc. Country Code)*

Country CodePhone Number
Date of Birth*

DayMonthYear
Date
Gender*
Level of English*
Main languages spoken*
Please separate with a comma: i.e. English, Spanish,
Emergency Contacts

You must provide two contacts
Name (Contact One)*

First NameLast Name
Phone Number (Inc. Country Code)*

Country CodePhone Number
Email*
example@example.com
Relationship*
Mother, Brother etc.
Country of Residence*
Name (Contact Two)*

First NameLast Name
Phone Number (Inc. Country Code)*

Country CodePhone Number
Email*
example@example.com
Relationship*
Mother, Brother etc.
Country of Residence*