Audax Japan Okayama

Audax Japan Okayama

BRM423 entry form for overseas riders

■Your name (*required field)
Family name First name

■Gender

■Birthday (*required field)
/ /

■Age (*required field)

■Contry (*required field)

■Postal code (*required field)

■Address (*required field)

■Cell phone (International roaming is recommended)

■Phone of emergency contact (*required field)

■Email of emergency contact (*required field)

■Name of emergency contact (*required field)

■Relation of emergency contact (*required field)

■Club name

■Club code

■Qualifications (*required field)

Fill in your past result. e.g. BRM717 Okayama 1000 (2014), Paris Brest Paris (2015) etc.
Please refer to the Qualification

■Your Email address (*required field)

■Insurance (*required field)
Please refer to the proviso of insurance.
Fill in your insurance information.
Insurance company
Type of Insurance
Contract number

■Preferred start time
【first choice】
【second choice】
Your time is decided by first-come first-served basis.

■Bike inspection

*Please check the drop bag restrictions before you choose an option.

■Welcome party (pasta restaurant / 2,000 JPY (tax included)

*You can sign up for the welcome party after finishing this registration. (Deadline on Feb.1)

■Note