TRACKER GUARANTEE

I, .………………………………………………….. Date of birth ……………………………

Currently residing at ………………………………………………………………………………………….

Commits to reimburse to the Ultracyclisme Association (registered in Bagnolet France), the sum of €200 in the event of loss, theft or deterioration of the tracker GPS, that was provided to me for the Poco Loco………………………….. event.

Signed this day of_______,_________,

Day Month Year

Signature