Medical Certificate

The undersigned M.D. …………………………………………………………………

Address ………………………………………………………………………..

City ……………………………………………………………………………..

Telephone ……………………………………

Certifies that the runner Mr./Mrs ……………………………………..

Date of birth ……./……/……

Has undergone a medical examination permitting him/her to participate in
LET’S GO RIO ULTRA RACE – 111km – 16h, and is not suffering from any illness
that might cause a prejudice to his/her health while competing.

Signature and seal