Hawai’i – Registration Form

    BaltiCCycle 2023

    5th OLYMPIC EXPEDITION - Continuation
    to
    Hawai'i

    Personal data

    Given names & surname

    Citizenship

    Personal code (if existing)

    Date of birth

    Place of birth

    Passport data

    Passport No

    Date of issue

    Date of expiry

    Issued by

    Contact data

    Street address

    City

    Postal code

    Country

    Telephones

    E-mail

    Chosen parts of the route / membership fee

    (Type the number of participation days, the registration fee will be estimated automatically.)

    Membership fee*:
    35 € / day

    Hawai'i
    25.02 – 26.03.2023, 30 days
    days

    TOTAL: dni
    * If the registration and the half of participation fee are not received before November 25, 2022, the membership fee increases by 15%. If the second part of the fee is not paid before February 1, 2023, the membership fee increases by 15%.
    FEE:
     

    Please enter the exact dates when you start and finish the ride.

    (If you plan to join several times enter the dates for every part of the route).
    Date of start 1

    Date of finish 1

    Date of start 2

    Date of finish 2

    I would like to receive a discount:*

    (Just one of displayed below.)

    10% – for students (until 26 years old), families (3 and more persons traveling together) and BC veterans who cycled more than 100 days in the previous BC tours.**

    privilege discount – negotiated personally for participants who obtain potential sponsors or support organizers before or during expedition in another way (preparing day descriptions, finding sleeping places, servicing bicycles, medical support, etc.).

    Data for discount (describe):

    * Discounts are applicable if the registration and the half of participation fee are received not later than before November 25, 2022.
    ** If a cyclist reaches 100 BC days during the ride, the discount is counted from the next day.

    TOTAL WITH DISCOUNT:

    I would like to purchase additional BC2023 T-shirts – 20 €/unit
    (one is included into the fee)

    Please enter the size of T-shirt:

    no T-shirtSMLXLXXL

    EMERGENCY FUND (liczba dni x 5 €)
    (Unspent money from the Emergency Fund will be returned in 60 days after the ride in proportion of the amount of your contribution.)

    FULL PAYMENT:

    NOTE. The participation fee must be paid before February 1, 2023; otherwise, it increases by 15%.

    Your comments:

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

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

    nr PL77 1050 1041 1000 0023 0551 6409
    nr BIC (SWIFT): INGBPLPW

    CROTOS Travellers’ Association
    6-57, Sobieskiego St.
    02-957 Warsaw
    Poland

    ING Bank Śląski
    The Corporation Branch II
    45, Malczewskiego St.
    02-622 Warsaw
    Poland

    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).

    If after clicking "Send" you will see such statement "There was a problem with your registration form" - please click "Send" one more time.