Registration Form – Hokkaido & Honshu

    BaltiCCycle 2023

    5th OLYMPIC EXPEDITION - Continuation
    TO JAPAN

    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

    Membership fee:
    30 €/day for 1–30 days
    27 €/day for 31–51 days

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

    Hokkaido: Wakkanai – Hakodate
    1-28.07.2023, 28 days
    days

    Honshu: Hakodate – Tokyo
    29.07-20.08.2023, 23 days
    days

    TOTAL: days
    * If the registration and the half of participation fee are not received before December 31, 2022, the membership fee increases by 10%. If the second part of the fee is not paid before June 1, 2023, the membership fee increases by 10%.

    OPŁATA:
     

    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.**

    a 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 December 31, 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 use the transportation service for my additional piece of luggage – 2 €/day
    (no more than 15 kg; 25 kg luggage is included in the registration fee)

    I will cycle 20 days or less but I would like to purchase BC2023 T-shirts – 20 €/unit
    (T-shirt for participants who register for more than 20 days – free of charge)

    I will cycle more than 20 days but I would like to purchase additional BC2023 T-shirts – 20 €/unit
    (one you get free of charge)

    Please enter the size of T-shirt

    no t-shirtSMLXLXXL

    FULL PAYMENT:

    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:

    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
    nr PL77105010411000002305516409
    nr BIC (SWIFT): INGBPLPW

    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.