rEGISTRATION FORM
-( 1 pEr participant )-

To be returned before mai 15, 2006 to :
SOLEX MILLENIUM « The 60 years of the Velosolex »
chez ID GRAPH
32, rue des 40 mines 
60000 – ALLONNE (France)

I wish to participate in the « 60 years of the Velosolex » event organized by  SOLEX MILLENIUM on June 3rd & 4th,2006 in BEAUVAIS-ALLONNE (France)

Last Name :		First Name :		
Birthday :		
Address :		
Zip code :		City,State :		
Country :		
Tel :		Gsm :		
e-mail :		
Club :		
TECHNICALS CHARACTRISTICS :
Model :		
Moteur number :		
Insurance code :		
Insurance company :		
Identification N° (green card) :		
The Solex must conform to the rules of the road, it must have tires and brakes in good condition as well as working signal lights.	
OPTIONS :
Participation in the swap meet/boot sale (free site) :	[ YES ]  [ NO ]	
Participation in the Solex assembly/disassembly:	[ YES ]  [ NO ]	

Costs of particpation in the 60 ans of the Velosolex event : 30 € includes meals on Saturday night and Sunday afternoon as well as the giving of a unique gift to each participant.

You must submit with this form :
•	Photocopy of the insurance green card.
•	Check made payable to Solex Millenium.
Payement to be made on the spot for participants residing outside France.

I declare that I have read and understand the rules of the “60 years of the Velosolex” event and that I obey them.

READ and APPROVED on (date)

 Signature