MICRO-MOBILITY WINTER GAMES 2020

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Micro Mobility Winter Games 2020, Brussels 7-9 February 2020

REGISTRATION TO THE COMPETITION IS VALID ONCE YOU HAVE SUBMITTED THE REGISTRATION FORM BELOW AND PAID THE REGISTRATION FEE TO BELGIUM WHEELERS ASBL.

Name *

First name *

Date of birth *

YYYY

Place of birth *

Postal address *

Complete address (Street, number, box, zipcode, community)

Telephone number *

Please use the international notation: +XX YY YYYYYY

Email address *

Belgian National Number or Passport Number for non-Belgian inhabitants *

Nationality *

Emergency Contact *

Please fill out name and mobile number

By filling out this form: *

I am registering to the Micro-Mobility Winter Games 2020 (MMWG) Competition organised by BELGIUM WHEELERS ASBL, taking place from Friday 7 February 2020 6.00pm until Sunday 9 February 2020 6.00pm at Tour & Taxis in Brussels (avenue du port 86C, sheds 3 & 4)

I am aware and accept the terms and conditions that will apply during the competition.

I would like to register for the MMWG 2020 competition in one of the following categories

Required

Type of vehicle:

Electric scooter

Electric skate

Electric unicycle

Onewheel

Clear selection

Brand: *

Model: *

Voltage: *

Power (W): *

Battery capacity (Wh) *

Weight (Kg) *

Electric unicycle

If a device qualifies for 2 categories based on voltage and power, the voltage takes precedence and determines the category.

Children 12 to 17 years old

Less than 50 V/less than 1000 Watts

Between 50 V and 84 V / Between 1000 and 2000 Watt

84 V / Above 2000 Watt

100 V

GW Monster 84 V (separate category if at least 3 registrations)

GW Monster 100 V (separate category if at least 3 registrations)

GW MSX 100 V

Clear selection

Electric Step

Above 701 Watt

Between 700 and 3000 Watt

Above 3000 Watt

Clear selection

Electric Skate

MTB DIY STRAP

MTB DIY NON-STRAP

STREET DIY

MTB BRAND STRAP

MTB BRAND NON-STRAP

STREET BRAND

Clear selection

Onewheel

Onewheel XR

Onewheel Pint

Clear selection

During the competition, I accept the following conditions: *

Each participant must use the same micro-mobility vehicle during the entire competition (exceptions are made in case of a technical problem or if a vehicle with similar power/model is used)

If a participant wishes to take part in several categories of competitions, then he must register to each separately

Required

Insurance: I accept the following: *

Benefit from the insurance concluded by BELGIUM WHEELERS ASBL covering the participants in the Competition, duly registered, during the scheduled periods of trials, qualifications and competitions. This insurance covers damage that may occur due to shortcomings by BELGIUM WHEELERS. Each participant remains responsible for his own behavior, conduct and will be held responsible for compensating the damage (bodily and material) following these actions.

Apart from training and events, at the times and places defined as such, the association is released from any responsibility concerning the civil liability of visitors, competitors, exhibitors concerning damage and damage for which they would be responsible under their compulsory civil liability, both within the Village and in marked places of the event as on public roads, which they must guarantee by their own personal and / or specific insurance for a land motor vehicle

In any case, this clause does not release the Participant from being insured as indicated below.

Required

I commit to paying the following registration fee: *

The payment must be done by bank transfer to the BELGIUM WHEELERS account (IBAN BE41 7350 5271 2010 - BIC : KREDBEBB), with the following reference: FAMILY NAME FIRST NAME MMWG 2020

20€ if my payment is credited on BELGIUM WHEELER's account before 21 January 2020 23:59

25€ if my payment is credited on BELGIUM WHEELER's account before 6 February 2020 23:59

30€ from 7 February 2020 23:59 on BELGIUM WHEELERS's account

30€ cash upon arrival at the registration desk

I accept the following: *

I have read and accept the BELGIUM WHEELERS ASBL Charter and commit to respecting it fully throughout the event.

I will respect all the rules and instructions set out by the Competition’s organisers and staff.

I have the necessary skill and ability to control all my micro-mobility vehicles to take part in the competition

I have the necessary physical condition to take part in this sport competition

I will wear the necessary protective gear, including a helmet, wrist-guards, knee and elbow-guards and back protection for strapped E-MTB riders. Shorts and open shoes are not permitted.

I will always have a fair-play attitude and be respectful of other participants.

I will not be under the influence of any substances that can change my judgment or reflexes (such as alcohol, drugs, etc.)

I accept that if I break any of the above rules, the Team will be allowed to penalise me or suspend my participation in the competition.

Required

I confirm/declare: *

That I have an obligation and declare that I hold a civil liability insurance valid throughout the Competition, covering any material, physical or moral damage that I would suffer during the Competition, or that I would cause to other participants or visitors .

To be informed that BELGIUM WHEELERS ASBL declines all responsibility, in particular in the event of loss, theft, accident, if necessary with damage of any kind (bodily, material, moral, etc.) suffered by a participant, or caused by a participant to another participant or to a third party, during the MMWG 2020

I declare that neither myself nor my insurer can invoke or engage the responsibility of BELGIUM WHEELERS ASBL due to the aforementioned damages

I declare that I have been notified and accept that for any reason whatsoever (injury, accident, illness or other), the amount paid is definitively acquired by BELGIUM WHEELERS and will not be reimbursed

Required

In order to comply with the "GDPR", I expressly agree to receive emails from BELGIUM WHEELERS ASBL by checking the "I accept" box below: *

GDPR legislation on personal data - I declare that I have been informed and accept that: a. All of my personal data (names, addresses, telephones, e-mail, national register number and VAT) constitutes a "member file" which is the exclusive property of BELGIUM WHEELERS ASBL; b. BELGIUM WHEELERS ASBL will keep this personal data private, with care, for the purposes of registration and / or participation in our activities; c. BELGIUM WHEELERS ASBL will only use this data for the purposes necessary for its proper functioning (registration, insurance, invoicing, delivery, contact persons, etc.); d. BELGIUM WHEELERS ASBL will only communicate this data to third parties with my express consent, and only for purposes determined by the needs of the organization of activities and the smooth running of them, in accordance with the General Data Protection Regulations ("GDPR"); e. My email address will be used regularly for the communication of information specific to BELGIUM WHEELERS ASBL: activities, changes within the ASBL, news and monthly and / or exceptional offers; f. At any time, I can ask to be removed from the BELGIUM WHEELERS ASBL database or to no longer receive emails from the ASBL; this request must be sent to BELGIUM WHEELERS ASBL by e-mail or letter; g. I can also exercise my right of access to my personal data, request to know the information available to BELGIUM WHEELERS ASBL, and if necessary request the modification of these data.

I accept

Required

Date and signature *

Date and full name of the participant, preceded by "Read and approved".

FOR PARENTS OF MINORS PARTICIPATING IN THE COMPETITION

Copy this text to the Response field and fill out the names: I undersigned ……………………………………………………authorise my child ……………………………………………………………… to take part in the MMWG 2020 competition. I have ensured that s/he is covered by the necessary insurance policies for the child and the vehicle that s/he will be using.

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