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  • LUT Medical Certificate

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    Ivan I
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    This document contains a medical certificate form required for participation in an ultramarathon race in accordance with Italian law. The form requires information about the participant including name, date of birth, nationality, and race. It must be completed by a doctor certifying that a medical examination revealed no contraindications to competitive running. The certificate must be uploaded by May 15th or the registration will be annulled without reimbursement. Nobody can participate without this certificate.

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    This document contains a medical certificate form required for participation in an ultramarathon race in accordance with Italian law. The form requires information about the participant including name, date of birth, nationality, and race. It must be completed by a doctor certifying that a medical examination revealed no contraindications to competitive running. The certificate must be uploaded by May 15th or the registration will be annulled without reimbursement. Nobody can participate without this certificate.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    34 views1 page

    LUT Medical Certificate

    Uploaded by

    Ivan I
    This document contains a medical certificate form required for participation in an ultramarathon race in accordance with Italian law. The form requires information about the participant including name, date of birth, nationality, and race. It must be completed by a doctor certifying that a medical examination revealed no contraindications to competitive running. The certificate must be uploaded by May 15th or the registration will be annulled without reimbursement. Nobody can participate without this certificate.

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    © All Rights Reserved
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    Surname: ______________

    First name: _____ _________

    Nationality: ______________

    Date of birth: ___ / ___ / ______

    2021 Race: LUT UD CT CS

    The certificate is in accordance with Italian law (DM 18/02/1982).


    In order to make sure that we treat all the certificates sent from different countries
    correctly, it is compulsory to use this form, no other will be accepted.
    This medical certificate has to be filled in, dated and signed by the doctor, who stamps
    it and specifies his professional number.
    This certificate must be uploaded to your personal runner space at www.ultratrail.it
    by 15 May 2021.
    Failure to do by this date will lead to the annulment of registration without
    reimbursement.
    Nobody will attend the race without the medical certificate.

    Medical Certificate
    Competitive sport activity
    (ONLY CAPITAL LETTERS)

    I, the undersigned doctor _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _


    certify that the medical examination of:
    Surname: . . . . . . . . . . . . . . . . . . . . . First name: . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    Born on the: ____ / ____/ ______, in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    Resident in . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
    does not reveal any contraindication to the practice of competitive Athletics sport activity
    (running).
    This certificate will expire on ___ / ___ / ______ .

    Date: ___ / ___ / ______

    Signature of doctor: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

    Professional stamp/seal and professional number: _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _

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