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SPORT MEDICAL CERTIFICATE LAGO MAGGIORE HALF MARATHON 06/03/2011 Medical Certificate request based on art. This Sport Medical Certificate is considered valid for the practice of sports at agonistic level Medical Certificate request based on art. 12/6 Norme per l Organizzazione delle Manifestazioni of the Italian Athletic Federation FIDAL Regulation concerning participation of foreign athletes and therefore participating with a Daily FIDAL Membership Card Cartellino Giornaliero to athletic competitions in Italy. Please fill in all spaces sign it and return by fax 39 0323 922 761 / e mail info pro motion*it / regular mail Sport PRO MOTION A. S*D. Via Marconi 3 28831 Baveno VB Italy Doctor. name surname Born city country On dd/mm/yyyy Office at complete address Phone/Fax number I hereby declare that Mr/Mrs/Ms name surname Resident at complete address Based on sport physical examination done on dd/mm/yyyy and fit to compete in a 21 0975 Km Lago Maggiore Half Marathon 06/03/2011 competition according to current Italian laws. 12/6 Norme per l Organizzazione delle Manifestazioni of the Italian Athletic Federation FIDAL Regulation concerning participation of foreign athletes and therefore participating with a Daily FIDAL Membership Card Cartellino Giornaliero to athletic competitions in Italy. 12/6 Norme per l Organizzazione delle Manifestazioni of the Italian Athletic Federation FIDAL Regulation concerning participation of foreign athletes and therefore participating with a Daily FIDAL Membership Card Cartellino Giornaliero to athletic competitions in Italy. Please fill in all spaces sign it and return by fax 39 0323 922 761 / e mail info pro motion*it / regular mail Sport PRO MOTION A. Please fill in all spaces sign it and return by fax 39 0323 922 761 / e mail info pro motion*it / regular mail Sport PRO MOTION A. S*D. Via Marconi 3 28831 Baveno VB Italy Doctor. name surname Born city country On dd/mm/yyyy Office at complete address Phone/Fax number I hereby declare that Mr/Mrs/Ms name surname Resident at complete address Based on sport physical examination done on dd/mm/yyyy and fit to compete in a 21 0975 Km Lago Maggiore Half Marathon 06/03/2011 competition according to current Italian laws. 12/6 Norme per l Organizzazione delle Manifestazioni of the Italian Athletic Federation FIDAL Regulation concerning participation of foreign athletes and therefore participating with a Daily FIDAL Membership Card Cartellino Giornaliero to athletic competitions in Italy. Please fill in all spaces sign it and return by fax 39 0323 922 761 / e mail info pro motion*it / regular mail Sport PRO MOTION A. S*D. Via Marconi 3 28831 Baveno VB Italy Doctor. name surname Born city country On dd/mm/yyyy Office at complete address Phone/Fax number I hereby declare that Mr/Mrs/Ms name surname Resident at complete address Based on sport physical examination done on dd/mm/yyyy and fit to compete in a 21 0975 Km Lago Maggiore Half Marathon 06/03/2011 competition according to current Italian laws.

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