This information will only be used in case of an accident or emergency. Please take the time to fill this in fully and to the best of your knowledge. By completing it you are agreeing that you are riding at your own risk and responsibility on open, public roads. Traverse Aravis Ltd or anyone acting for them will not take responsibility for any accidents/incidents that may happen.

Personal Details

Name

First Name

Last Name

Date of Birth

YYYY

Mobile Number

Email Address

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Passport Number

Place of Issue

of Passport

Next of Kin

Name and Telephone Number

Medical Conditons and Dietary Requirements

Please state any medical conditions, allergies or dietary requirements

European Health Insurance Card

EHIC Identification Number

It is important to note that this does not replace the requirement for Travel Insurance as it does not cover repatriation or any private emergency care. However, it really helps when admitted to a European Hospital. Please carry this with your ID (drivers license) on you on your bike (write Carte Vitale if you are a french resident)

EHIC Identification Number of Institution

EHIC Identification Number of the card

Insurance Details

Insurance Company Name

It is mandatory that you organise your own travel insurance that provides suitable cover for road cycling. By filling out this form you are agreeing that you will be riding under your full responsibility on open roads. Traverse Aravis Ltd will not take any responsibility for accidents that may occur.

Insurance Contact Number

Insurance Policy Number

Disclaimer

By completing this form, you are agreeing that you are riding at your own risk and responsibility on open, public roads. Traverse Aravis Ltd or anyone acting for them will not take responsibility for any accidents/incidents that may happen.

I have read and understood

Ripcor L2B Info