REGISTRATION

ASSOCIAÇÃO REGIONAL DE CANOAGEM DA MADEIRA

Avenida Sá Carneiro

Centro Náutico São Lázaro, Hangar 4

9000-017, Funchal

arcm.moc@gmail.com

(+351) 291764330

(+351) 967878694
REGISTRATION

MADEIRA LIFESAVING CHALLENGE
NAME (FIRST & LAST)*
GENDER*
LICENCE NUMBER*
CLUB*
NATIONALITY*
MOBILE*
EMAIL*
BIRTH DATE*

DAYMOUNTHYEAR
INCLUDED IN REGISTRATION:

T-SHIRT
DINNER AT VENUE
TRANSFER TO THE VENUE AND BACK (IF CHOSEN)
MADEIRA LIFESAVING CHALLENGE IS OPEN FOR THE FOLLOWING CATEGORIES*

SS1 ELITE MEN (10€)SUPC ELITE MEN (10€)SS1 ELITE WOMEN (10€)SUPC ELITE WOMAN (10€)
T-SHIRT SIZE*

SIZE SSIZE MSIZE LSIZE XL
TRANSFER TO VENUE (AND BACK) OF MADEIRA LIFESAVING CHALLENGE*

YESNO
TOTAL COST:
CONDITIONS:

IN ORDER FOR YOUR REGISTRATION BE VALIDATED, PAYMENT MUST BE MADE TO ASSOCIAÇÃO REGIONAL CANOAGEM DA MADEIRA:

- BANK TRANSFER IBAN: PT50 0018 000353099826020 08
- BANK TRANSFER BIC/SWIFT: TOTAPTPL
(IDENTIFICATION OF THE NAME WITCH WAS USED IN THE REGISTRATION)

- MBWAY PARA O Nº 967878694
(IDENTIFICATION OF THE NAME WITCH WAS USED IN THE REGISTRATION)

SEND PROOF OF PAYMENT TO arcm.moc@gmail.com
Should be Empty: