광주 Brevets - 2013 - Gwangju Brevets

Registration Form (가입신청서)

Name (이름)

Korea Randonneurs Membership number (코리아 란도너스 회원번호)

300K Gwangju-Busan (광주-부산) (2013-09-07)

check / 체크

600km Gwangju-Busan-Gwangju (광주-부산-광주) (2013-09-07)

check / 체크

For information about membership- and registration fees, please refer to the website, page "How to Register"

멤버쉽에 대한 더 자세한 정보와 등록비는 "등록방법" 페이지를 참고해주세요.

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For NEW members and in case of change of personal data: (신입과 개인정보수정용)

Family name, first names (for everyone) (영문이름):

Full name in Hangeul (for Koreans) (한글이름):

Full name in Japanese (for Japanese):

Address in Hangeul (for Koreans) (한글주소):

Address in English (영문주소):

Year of birth (출생년도):

In actual military service? (현역 복무중?)

check / 체크

Nationality / 국적

Mobile phone / 휴대폰번호

Email address / 이메일주소

Eventual health concerns (건강상 문제점):

In Case of Emergency to contact (tel. no.) (비상시 연락처 - 전화번호)

In Case of Emergency to contact (name) (비상시 연락처 - 이름)

In Case of Emergency to contact (relation) (비상시 연락처 - 관계)

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