Invitation 2015 Ulysse Trophy - Union Internationale de ... · Invitation 2015 Ulysse Trophy.pdf...
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Transcript of Invitation 2015 Ulysse Trophy - Union Internationale de ... · Invitation 2015 Ulysse Trophy.pdf...
Federazione Italiana Pentathlon Moderno Via Vitorchiano 113, 00189 ROME (ITA)
email: [email protected]
Entry Form “A” (Informative) Return before April 15, 20150 Nation:
Contact:
Telephone:
Fax:
E Mail:
YES NO
Participation
CATEGORIES Number BOYS Number GIRLS
YOUTH A
YOUTH B
YOUTH C
YOUTH D
YOUTH E
YOUTH F
MEN WOMEN
Officals/Technicians
Others
TOTAL
DATE:_______________ SIGNED:_________________________
Return to: [email protected] – fax +390691516825
Federazione Italiana Pentathlon Moderno Via Vitorchiano 113, 00189 ROME (ITA)
Return before MAY 10, 2015 ! ! !!!!!!!!!!!!!!!Entry!Form!“B”!!Nation:
Email:
CAT SURNAME NAME SEX
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MEN WOMEN
Officals/Technicians
Others
ACCOMODATION: Mark with “X”:
The Delegation will stay in the Official Hotels YES NO
IF YES:
In Mentana :
Triple rooms n. _______ from_____________ to____________
Four rooms n. _______ from_____________ to____________
TRANSPORT :
The Delegation need: YES NO
Return to: Federazione Italiana Pentathlon Moderno
Email: [email protected]
Signature: ________________________________
Name (printed): Date:
SIGNED:_________________________
Federazione Italiana Pentathlon Moderno Via Vitorchiano 113, 00189 ROME (ITA)
Return before June 5, 2015 ! ! !!!!!!!!!!!!!!!Entry!Form!“FINAL”!!Nation:
Email:
Please write all name and surname of Athlete and Coaches
CAT SURNAME NAME SEX ARRIVAL
DATE
DEPARTURE DATE
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Please send also the copy of bank transfer.
Return to: Federazione Italiana Pentathlon Moderno
Email: [email protected]
Signature: ________________________________
Name (printed): ______________________ Date: ____________________
SIGNED:_________________________
!
INFO
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ATIO
N R
EQ
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FOR
GU
NS PE
RM
IT
pistolpistol
model
number
full name as in passport
date of birthgender
citizenshippassport num
ber
