Centurio Circuit :: Player Registration

Division:^*	D1 D2 C5
	Note: if you select D1 or D2 division, you will be unable to change it to C5 later.
First Name:^*
Last Name:^*
	Note: spelling of your name must be identical to your valid document (passport, driver's license, etc.) Use ENGLISH letters only!
Is Middle Name or Nick Available?
Middle Name/Nick:

Birth Date:^*	/ /
Gender:^*	Male Female
Country:^*
City / Town:
Phone Number:	+ ()

Important: Make sure that your e-mail is valid because your ID number will be sent to your address. You will also need access to this e-mail address in the future.
E-mail:^*
Repeat Email:^*
Password:^*
Repeat Password:^*
Enter Code (digits only):^*

Photo:
	Only .jpg quality images (300dpi, 30x40 mm = 354x472) are acceptable max. file size: 150K
Subscribe to Newsletter?	Yes


Please contact vika@centurio-eepl.comif you have any questions or suggestions.

Player Registration Form