How to submit your application

Please carefully follow the steps below:

1. Fill in your personal information

2. Attach your medical documents

3. Complete all required information

These steps are mandatory for the processing and review of your application. Mandatory information is marked with an * below.

General Information

Last name

First name

MyUTMB email address

Date of birth

Sex

Medical category (related to your injury/condition)

Please describe your diagnosed pathology/illness

Diagnosis of your condition

Please attach any relevant documents related to the diagnosis Accepted formats: PDF, JPG, PNG

Date of onset of symptoms

Date of diagnosis

What additional examinations were carried out to establish this diagnosis?

Please attach any relevant documents related to these examinations Accepted formats: PDF, JPG, PNG

Management of your condition

What treatment or care are you receiving (medication, rehabilitation, etc.)?

Please attach any relevant documents related to this treatment/care (prescriptions, etc.) Accepted formats: PDF, JPG, PNG

How long is your treatment/care expected to last?

Estimated date of return to training

Estimated date of return to competition

Doctor's last name

Doctor's first name

Doctor's specialty

Please explain the reasons why you are requesting a bib deferment.

Data Protection (GDPR / HDS)

Personal data, including health-related information, provided as part of this priority registration request is strictly confidential and will be hosted on an HDS-certified (Health Data Hosting) infrastructure in France. It will be processed solely by the UTMB Group as the data controller and will be shared with the doctors on the medical committee of the Friends of the UTMB Mont-Blanc: https://www.amis-utmb.org/commission-medicale

This data will be processed based on your consent and will be used solely for the purpose of evaluating the validity of the request to defer your race number. Under no circumstances will it be shared, transmitted, or used for any other purpose. For more information on the terms of priority registration, please consult our Policy on Priority Registration for Medical Reasons at the following address: https://montblanc.utmb.world/fr/politique-priorite-inscription

The identification data (excluding health data) submitted via this form, as well as the medical committee's opinion, are retained by UTMB Group for a period of three years. At the end of this period, the data are anonymized and will be retained for statistical purposes and to improve the service. Health data submitted via this form is retained only by the medical committee of the Friends of the UTMB Mont-Blanc (UTMB Group does not have access to it) for a period of five years.

You have the right to access, rectify, erase, restrict processing, withdraw consent, object, and request data portability. You may exercise these rights by contacting: dpo@utmb.world. You also have the right to file a complaint with the CNIL.

For more information about your rights and how UTMB Group processes your data, please review our privacy policy at the following link: https://utmb.world/fr/privacy-policy

I consent to UTMB Group, as the data controller, processing my personal data provided in this form in order to review my request for priority registration for medical reasons in accordance with the terms specified above and as set forth in the UTMB Group Privacy Policy: https://utmb.world/fr/privacy-policy

HOKA UTMB Mont-Blanc

For any new application, please complete this form.

Please note: Make sure to check the spelling of names, surnames, and email addresses before submitting the form.

montblanc@service.utmb.world

31 Rue du Lyret
74 400 Chamonix-Mont-Blanc, France

HOKA UTMB Mont-Blanc

Priority Registration Policy for Medical Reasons Form

How to submit your application

Please carefully follow the steps below:

1. Fill in your personal information

2. Attach your medical documents

3. Complete all required information

These steps are mandatory for the processing and review of your application. Mandatory information is marked with an * below.

General Information

Diagnosis of your condition

Management of your condition

Data Protection (GDPR / HDS)

HOKA UTMB Mont-Blanc

For any new application, please complete this form.

Please note: Make sure to check the spelling of names, surnames, and email addresses before submitting the form.