Bib N°:
Space reserved for the organization
« Le Grand Raid des Pyrénées »
August 26, 27 and 28, 2016
MEDICAL CERTIFICATE
Authorization to enter a running race on mountain trails
I, the undersigned, Doctor……………………………………..Phone number : ………………….
Adress……………………………………………………………………………………………….
Zip Code :………………………. Town……………………….Country………………………….
CERTIFY HAVING EXAMINED ON ….…./…./…...…, MRS, MS, MR :
Surname :…………………………. Firstname :………………….. Birthdate :____/____19____
And I did not find any medical reason forbidding her/him to participate to the GRAND RAID DES
PYRENEES race whose specificities are described hereafter :
□
□
□
GRP80 – Le Tour des Lacs : 80 kilometers and 5000 meters positive ascent
GRP120 – Le Tour des Cirques : 120 kilometers and 7000 meters positive ascent
GRP160 – L’Ultra : 160 kilometers and 10000 meters positive ascent
Furthermore, my examination did not reveal any heart or lung disease which
forbids a running activity in a mountain environment, nor articular or muscular
problems.
STAMP AND DOCTOR’S SIGNATURE
Important
It is not possible to run the race without
this certificate correctly filled in by a
doctor after August 29th 2015.
MEDICAL CERTIFICATE TO BE UPLOADEDED VIA WEBSITE
http://www.grandraidpyrenees.com/
OR TO RETURN, BEFORE JULY 10th 2016, TO
ASSOCIATION MAJUSCHULE
Grand Raid des Pyrénées
63 rue Bellecombe
69006 LYON