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BRM CIN 100, Čakovec 2015
Randonneur ______________________________________
prijavljujem se na brevet koji će se održati u Čakovcu 28.03.2015.
IZJAVLJUJEM
- da sam u dobroj tjelesnoj kondiciji
- da imam uredno obavljen lječnički pregled kojim se utvrđuje sposobnost bavljenja amaterskim biciklizmom
- da sam zdravstveno osiguran za slučaj nezgode
- da nisam pod utjecajem nedozvoljenih sredstava (alkohol, droga, doping,..)
- da ću koristiti zaštitnu kacigu
- da sam dobio(la) plan puta i da sam upoznat(a) sa trasom Breveta
- da ću poštovati pravila BRM
- da ću se pridržavati Zakona o sigurnosti u prometu na cestama
- da neću svojim ponašanjem ometati ni ugrožavati ostale sudionike u prometu
-da ću se ponašati sukladno pravilima lijepog ponašanja
- da vozim na vlastitu odgovornost
Suglasan sam sa slijedećim
- da trasa Breveta nije posebno označena (osim u planu puta-roadbook)
- da Brevet nije utrka, već vožnja i druženje
- da na trasi Breveta nema organizirane tehničke, medicinske ili bilo kakve druge pomoći
- da organizator neće organizirati pomoć ukoliko odustanem
- da organizator ne odgovara za moguće nezgode i nastale štete
- da organizator može koristiti moje podatke prilikom objave rezultata
U Čakovcu, 28.03.2015.
Potpis:
___________________________
BREVET DE RANDONNEURS MONDIAUX
Randonneurs Croatie 230000
BRM CIN 200, Čakovec 2015
Randonneur ______________________________________
prijavljujem se na brevet koji će se održati u Čakovcu 28.03.2015.
IZJAVLJUJEM
- da sam u dobroj tjelesnoj kondiciji
- da imam uredno obavljen lječnički pregled kojim se utvrđuje sposobnost bavljenja amaterskim biciklizmom
- da sam zdravstveno osiguran za slučaj nezgode
- da nisam pod utjecajem nedozvoljenih sredstava (alkohol, droga, doping,..)
- da ću koristiti zaštitnu kacigu
- da sam dobio(la) plan puta i da sam upoznat(a) sa trasom Breveta
- da ću poštovati pravila BRM
- da ću se pridržavati Zakona o sigurnosti u prometu na cestama
- da neću svojim ponašanjem ometati ni ugrožavati ostale sudionike u prometu
-da ću se ponašati sukladno pravilima lijepog ponašanja
- da vozim na vlastitu odgovornost
Suglasan sam sa slijedećim
- da trasa Breveta nije posebno označena (osim u planu puta-roadbook)
- da Brevet nije utrka, već vožnja i druženje
- da na trasi Breveta nema organizirane tehničke, medicinske ili bilo kakve druge pomoći
- da organizator neće organizirati pomoć ukoliko odustanem
- da organizator ne odgovara za moguće nezgode i nastale štete
- da organizator može koristiti moje podatke prilikom objave rezultata
U Čakovcu, 28.03.2015.
Potpis:
___________________________
BRM 100 km Čakovec, 2015.
LIABILITY STATEMENT
Randonneur: _____________________________
Is registering to the 200 km Čakovec 2015, start of which is on March 28.-th, 2015.
By signing I do declare:
- That I am in a good physical shape,
- That I have a medical certificate stating that I am capable of participating long distance amateur
riding,
- That I have a valid health insurance,
- That I have received the road book and brevet map,
- That I am under no influence of banned substances of any kind (alcohol, drugs, etc),
- That I will wear protective helmet at all times and have front white and rear red lights on, as well
as the reflective vest or sash during the night and times of poor visibility,
- That I will respect the rules to the Brevet Randonneur Mondiaux,
- That I will respect the Croatian Traffic Safety Law,
- That I will not impede nor endanger other traffic participants,
- That I will respect of the code of good conduct,
- That I will ride on my own risk and responsibility.
Also, I am compliant with the following:
- That the course of the brevet is not specifically indicated on the roads other that found in the road
book and the brevet map,
- That brevet is not a race, but rather a ride and hanging out and riding with other randonneurs,
- That during the brevet I am self sufficient, and that there are no organized technical, medical, or
other help of any kind along the course of the brevet,
- That organizer is not obligated for any assistance in case of DNF,
- That organizer is not responsible for accidents and possible damages among riders and to third
parties,
- That organizer may use data I've provided in my Application Form exclusively for purpose of the
results publication.
Čakovec, Marchuly 28.th 2015
Signature:
_______________________
BREVET DE RANDONNEURS MONDIAUX
Randonneurs Croatie 230000
BRM 200 km Čakovec, 2015.
LIABILITY STATEMENT
Randonneur: _____________________________
Is registering to the 200 km Čakovec 2015, start of which is on March 28.-th, 2015.
By signing I do declare:
- That I am in a good physical shape,
- That I have a medical certificate stating that I am capable of participating long distance amateur
riding,
- That I have a valid health insurance,
- That I have received the road book and brevet map,
- That I am under no influence of banned substances of any kind (alcohol, drugs, etc),
- That I will wear protective helmet at all times and have front white and rear red lights on, as well
as the reflective vest or sash during the night and times of poor visibility,
- That I will respect the rules to the Brevet Randonneur Mondiaux,
- That I will respect the Croatian Traffic Safety Law,
- That I will not impede nor endanger other traffic participants,
- That I will respect of the code of good conduct,
- That I will ride on my own risk and responsibility.
Also, I am compliant with the following:
- That the course of the brevet is not specifically indicated on the roads other that found in the
road book and the brevet map,
- That brevet is not a race, but rather a ride and hanging out and riding with other randonneurs,
- That during the brevet I am self sufficient, and that there are no organized technical, medical, or
other help of any kind along the course of the brevet,
- That organizer is not obligated for any assistance in case of DNF,
- That organizer is not responsible for accidents and possible damages among riders and to third
parties,
- That organizer may use data I've provided in my Application Form exclusively for purpose of the
results publication.
Čakovec, Marchuly 28.th 2015
Signature:
_______________________