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Family name:*	Given name:*	Nat.:* ---- Austria Czech Republic Germany Hungary Italy Slovakia Slovenia Switzerland --- Afghanistan Albania Algeria American Samoa Andorra Angola Antigua and Barbuda Argentina Armenia Aruba Australia Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil British Virgin Islands Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Chinese Taipei Colombia Comoros Congo Cook Islands Costa Rica Croatia Cuba Cyprus Dem. Rep. of the Congo Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Färöer Fed. States of Micronesia Fiji Finland France Gabon Georgia Ghana Great Britain Greece Grenada Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Honduras Hong Kong Iceland India Indonesia Iran Iraq Ireland Israel Ivory Coast Jamaica Japan Jordan Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mexico Moldova Monaco Mongolia Montenegro Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands New Zealand Nicaragua Niger Nigeria North Korea Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Poland Portugal Puerto Rico Qatar Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Gr. Samoa San Marino São Tomé and Príncipe Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Solomon Islands Somalia South Africa South Korea South Sudan Spain Sri Lanka Sudan Suriname Swaziland Sweden Syria Tajikistan Tanzania Thailand The Gambia Togo Tonga Trinidad and Tobago Tunisia Turkey Turkmenistan Tuvalu Uganda Ukraine United Arab Emirates United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands Yemen Zambia Zimbabwe	Year of birth:*	UCI-ID:*	Category:* - Men Elite Men U23 Women Elite Women U23 Amateure m Men Junior Women Junior Masters 1 Masters 2 Masters 3 Masters 4 Masters 5 Masters 6 Women Masters

Team/Club:	Email address:*	Phone number:

Race*:     R1 60min: ÖM Amateure R2 40min: ÖM Masters R3 40min: ÖM Junioren R4 50min: ÖSTM Frauen, U23, ÖM Juniorinnen R5 60min: ÖSTM Elite/U23

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