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OFFICIAL REGISTRATION FORM
PAN AMERICAN MASTERS
TRACK & ROAD CYCLING
November 7 al 13 - 2022
Bucaramanga - Barrancabermeja
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COUNTRY/DELEGATION
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Your answer
Number Phone Delegation:
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Your answer
FIRST NAME(S):
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Your answer
LAST NAME(S):
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Your answer
LICENCES:
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Your answer
E-MAIL:
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Your answer
PHONE NUMBER:
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MODALITY
:
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Track
Road
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Categoría:
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Choose
A1 (30-34 years) 1988-1992
A2 (35-39 years) 1983-1987
B1 (40-44 years) 1978-1982
B2 (45-49 years) 1973-1977
C1 (50-54 years) 1968-1972
C2 (55-59 years) 1963-1967
D1 (60-64 years) 1958-1962
D2 (65 and up) Before 1957
TRANSPORT LOGISTICS INFORMATION
HOTEL INFO (BUCARAMANGA TRACK):
Hotel name:
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Address:
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Phone:
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HOTEL INFO (BARRANCABERMEJA ROAD):
Hotel name:
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Address:
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Your answer
Phone:
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FLIGHT INFORMATION:
FLIGHT ARRIVAL INFORMATION
DATE OF ARRIVAL
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MM
/
DD
/
YYYY
TIME OF ARRIVAL:
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Time
:
AM
PM
CITY OF ARRIVAL
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AIRLINE:
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FLIGHT NUMBER:
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FLIGHT DEPARTURE INFORMATION:
DATE OF DEPARTURE:
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MM
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DD
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YYYY
CITY OF DEPARTURE:
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TIME OF AIRPORT
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Time
:
AM
PM
AIRLINE:
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FLIGHT NUMBER:
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