Name of the Super Randonnée
Date of Birth
Mailing Address (where the documents will be sent)
Club Affiliation (or « no license »)
Club Name (or « independant rider »)
Option: Randonneur or Touriste
if Randonneur, please indicate your date and starting time
By registering for the Super Randonnée, the participant declares on his / her honor that he / she is in sufficient physical condition to complete the course chosen, and to have read the safety instructions.
By registering for the Super Randonnée, the participant declares on his / her honor that he / she has read the following information:
Participants are strongly advised to take out individual accident insurance extended for cycling (unless they have a sports license including such insurance).
Registration can be done by email to: firstname.lastname@example.org
The registration fee is 5 euros.
Payment via PayPal: send 5,50 euros at email@example.com
Bank transfer: please contact us for the bank details
Money orders or checks (only if drawn from a French bank) must be payable to Provence Randonneurs, and sent to :