News routes LCC Seaside Cycle Route BaltiCCycle Tours Press Services shop

BaltiCCycle Tours

Year

Description / Program / Registration / Conditions


BaltiCCycle 2019

“The Carretera Austral – on an Ultimate World Road”

2019.02.23 - 04.13

REGISTRATION FORM

Given names & surname
Citizenship
Personal code (if existing)
Passport data
Passport No.
Date of birth
(dd.mm.yy)
Place of birth
Date of issue
(dd.mm.yy)
Date of expiry
(dd.mm.yy)
Authority
Address
Street address
City
Postal code
Country
Telephones
E-mail

Chosen parts of the route / membership fee
(sign with mouse left-click button the country and type the number of days; the registration fee will be estimated automatically)
Country Dates Number of days The chosen route Membership fee, €
Country Number of days 22 €/day
The Carretera Austral:
Puerto Montt – Villa O’Higgins
02.23-03.19 25
The Southern Patagonia:
Villa O’Higgins – Punta Arenas
03.20-04.07 19
Optional:
excursion to Puerto Williams
04.08-04.13 6
TOTAL 02.23-04.13 50  

Please, enter exact dates when you start and finish the ride. If you plan to join 2 times enter the dates for every part of the route.
Dates of start
Dates of finish

I would like to receive a discount (one of below displayed)
15% - students (not more than 26 years old), families (3 and more persons); long term travelers who cycled in the previous BaltiCCycle tours (2003-2018) 100 days and more; if a cyclist reaches 100 days during this ride, the discount is counted from that day;
special discount - participants who obtain potential sponsors or support organizers before or during the expedition in another way will (preparing the route, driving the support car, medical or bicycle service, etc.) receive a privilege discount negotiated personally;
no discount.
Data for discount

Note: The discounts are applicable only if the registration and a half of the membership fee are received by the close of the business day on November 30, 2018. The second part of the fee must be paid 5 days before your start, otherwise the whole fee will increases by 10%. Participants who do not have any discount, must pay the fee at least 20 days before their start date; otherwise the fee increases by 10% as well.

TOTAL WITH DISCOUNT: 0

I would like to use the transportation service for my additional piece of luggage (up 20 kg) during the ride - 2 €/day (remember that the transportation of one standard bag is included in the registration fee)
Yes No

I would like to purchase an additional BC2019 T-shirt – 15 € per unit
Yes No

FULL PAYMENT: 0

Your comments

I am familiar with the "Conditions of Participation" of the ride and agree with "Rules and Treaty for Participation and Responsibility"

In 5 days after the successful registration you will receive email confirmation with total amount of registration fee which must be paid to:

GMPR Lithuanian Fund,
AB SEB BANKAS,
BIC=SWIFT: CBVI LT 2XXXX,
IBAN: LT83 7044 0600 0115 2710

ALL BANK REMITTANCE CHARGES MUST BE PAID BY PARTICIPANT.

I confirm that the information provided is correct
I hereby agree to the processing of my personal data for the registration purposes in accordance to the Personal Data Protection Act from 28 August, 1997 (Journal of Laws No 101, item 926)






Friends:
catdays.net