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When I did the Marmotte for the first time, the guy running the trip only told me I needed a GP certificate as we were arriving in Alpe d'Huez. Luckily I had a Nokia 9210 and created a fake letter which I then faxed to the fax machine in the place we were picking up the bedding and towels from.
The person on the registration desk barely glanced at it.
andyp
Etape du Tour insisted on a medical certificate to ride a few mountains in a day. Rumour has it they were bombarded with thousands of fakes every year.