MEDICAL CERTIFICATE

I, the undersigned Dr ___________________________________ , medical doctor,

certify that the examination of:
Full name : Lubeck Yuridys Montesqu
Date of birth : 14 Oktober 1976
Age : 41 yrs
does not reveal any indication against performing in competitive trail running race.

Race name : BDG100K Ultra

Race distance : 100 K / 100ekiden / 50 K / 25 K*
*delete as appropriate

Date: 15 Agustus 2018

Doctor’s signature Stamp of the doctor (or professional contact)

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