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
DOLICHOS ULTRA RACE – 255km – 48h, and is not suffering from any illness
that might cause a prejudice to his/her health while competing.

Signature and stamp

The medical certificate must not be issued prior to 20/3/2025 (2 months before the race)