Inscription form

Β  Print or copy and paste it on the mail, complete and send it to Fire Gym (adres or mail)

First name………………………………………..…:Name:………………………………..
E-mail:…………………….@………………. & Website:Β  www…………………………..Β Β Β Β 
Phone:………/……………………………..Cellular:Β  ………./…………………………….
Address: ……………………………………………………………………………n°………
City:……………………………………………………………….Postal Code:…………….
Nationality:……………………………Sports & Hobby’s:………………………………….

0 Send me more information about the Peace Race Bagdad
0 I like to participate at the Children Peace Race in BagdadΒ  12-19 april 2003 and pay an
Β  account of 200€Β  (Fire Gym 210-0552848-97 “Account Peace Race Bagdad april)

0 I send my photo and a brief public motivation for the Peace Race website www.peacerace.beΒ 
0 I will support this initiative financially : Fire Gym 210-0552848-97Β  “Support Peace Race Bagdad"

Fire Gym, Sportcenter for the People, Rue Auguste Hainaustraat 48c, 1090 Jette,Β  info@peacerace.be

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