NEU. The ExtraMileEndurathon

EXTRAMILEENDURATHON.COM

APPLICATION FORM


Choice of City


Picture (jpg)
First Name*
Last Name*
Nationality
Birth Day
[minimum age:
18 years]







Day Month Year

 

Your eMail*
Your Cell Phone*
City you live in
Your Occupation

Languages you speak

English
German
Spanish
French
Portugese
Japanese
any other language:


Why I think I can win the ExtraMileEndurathon



I will arrange to have free time available for (an estimated maximum of)
10 days nonstop, 24 hours a day participating in the EtraMileEndurathon.com
and talking to members of the press.

My support staff: minimum 1 person at any time for personal support and help:

Number of support people*
Names of support staff*

eMail

Cell phone nr.


Medical Conditions

I am healthy with no medical treatment at this time

Medical treatment is needed as following:

GlobalGamesGroup, LLC hereby confirms privacy on all given personal data
within this application, only used for the selection of all participants and
the actual events.

Choice of competitors is determined by producers
of GlobalGamesGroup, LLC.

   
Security question*
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EXTRAMILEENDURATHON.COM