ENTRY FORM - 6th EDITION

ADIGEMARATHON – TERRADEIFORTI

19 OCTOBER 2009

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MODIFY EXISTING ENTRY

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Category:	Select Category C1 Whitewater Junior C1 Whitewater Boys C1 Whitewater Senior C1 Olympic Junior C1 Olympic Senior C2 Whitewater Junior C2 Whitewater Boys C2 Whitewater Senior K1 Men Whitewater Junior K1 Men Whitewater Master K1 Men Whitewater Boys K1 Men Whitewater Senior K1 Men Olympic Junior K1 Men Olympic Master K1 Men Olympic Senior K1 Women Whitewater Junior K1 Women Whitewater Master K1 Women Whitewater Girls K1 Women Whitewater Senior K1 Women Olympic Junior K1 Women Olympic Senior K2 Men Olympic Junior K2 Men Olympic Master K2 Men Olympic Senior K2 Women Olympic Junior K2 Women Olympic Senior OC1 Femminile OC1 Maschile Open Junior OPEN Women Senior OPEN Men Senior Iscrizione Amatori
		boat partner:
Family Name:
Given Name:
Nationality:	--- ARG AUT BEL BIH BRA CAN CHN CIV CRO CZE DEN ESP FIN FRA GBR GER GRE ITA LIE LUX MKD NOR POL POR RUS SLO SRB SUI SVK SWE TUR UKR USA
Club:
Date of birth:	Day: Month: Year: Place:
Address:	ZIP Code: Town: Street:
Email:
Repeat Email:
Cell.Phone:
With my entry submission I declare the following:
The organizers are allowed to process my personal data according to italian law D.Lgs.196/2003.
That I am physically prepared to practice canoe and that I decline any responsibility towards the origanizing committee.
That I am a member of a regular ICF member federation
That I give consens to process my image for broadcasting and (multi) media purposes during the duration of the event.