www.comisariouci.com
FEDERACIÓN DE CICLISMO
PLANILLA DE INSCRIPCIÓN PRUEBAS DE PISTA
ORGANIZACIÓN___________________________________________________________________________________
CATEGORÍA _________ FECHA ____/____/____ VELÓDROMO _____________________________________________
PAÍS __________________________________________________________ CÓDIGO PAÍS _______________
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NOMBRES |
COD/UCI |
CAT |
VEL -200 Mts |
KILOMETRO - 500 |
PI |
PXE |
SCR |
KEI |
VXE |
AME |
OMN |
CXP |
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ENTRENADOR / DELEGADO__________________________________________________________________________
HOTEL ________________________________ TEL ______________________ CEL _________________________
FIRMA___________________________
MEDELLÍN – COL
TEL.+57+4+266 33 08
CEL :+57+310+3961517
cexar67@hotmail.com