Dutch Gay and Lesbian Athletics

Registration form

Deadline preregistration: April 19th!
Only for the roadrace, also registration possible at May 2nd (9.30-10.45), costs 10,- euro

You can register for only one road event.
You can register for all track events.
A road event can eventually combined with running distances at the track, but not with all field events.

IMPORTANT: Within 1 day your registration will be confirmed by the anniversary committee. If you do not receive a confirmation within 1 day please contact the committee at jubileum@dgla.nl.

If you encounter any problems during registration please contact jubileum@dgla.nl.

Personal information

Family Name:
First Name:
Date of birth (day/month/year):
Street name+number:
Postal code:
City:
Country:
E-mailaddress:
E-mailaddress:
Phone number:
Club name:
Gender:	Female Male Transgender
Special needs:

	I declare that the organisation DGLA cannot be held responsible for any personal injury or damage.

Registration events
Road event:	5.000m 10.000m 15.000m no road event
Track & field events (more options possible):	100m 200m 400m 1500m long jump high jump shot put javelin 3000m race walk 5000m race walk discus triple jump pole vault
Dinner & Party:	Number of tickets

Registration for the sprint relay of 4x100m and/or the fun relay of 4x100m can be done at the day. Participation is FREE.

Fees
road discipline only track & field disciplines only road and track & field disciplines diner & party	7 euro 10 euro 15 euro 20 euro
	Euro

Please note that your registration is not valid until the payment due has been received by the organization.

Payment method

You can transfer the total amount due to bank account number 9270946 (Postbank) of DGLA, Amsterdam, with reference to ‘Lustrum 2009’ and your name.

IBAN code for international bank transfer: NL46 PSTB 0009 2709 46

(BIC code Postbank: PSTBNL21)