ENTRY FORM
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Name of the Club:
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Address of the Club:
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Contact Person:
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Phone number:
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Fax:
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E-mail:
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We will participate in the
following category (please cross clearly with X):
First
Category (born 2000 and younger)
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Second
Category (born 1998 and younger)
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Bank: LA CAIXA
IBAN: ES71 2100 5423 82 0200025833
SWIFT: CAIXESBBXXX
[Please state
CLEARLY on the payment order: Participation payment “I
ANDORRA BWMF CUP 2013” followed by the name of the Club without abbreviation. Example: NOT “CNSA” BUT
“SANT ANDREU”].
Name:
Date:
Signature:
___________________________
President or Secretary of the Club
The
undersigned, under his own responsibility, attests the fitness qualification
for competitive sport of the participants. ( players born in 2003 will not be
allowed in the tournament).
Also declares that he has examined Attachments 1, 2, 3, 4, especially
about privacy and Parental permission for
use of child's image.
If
you do not send us the signed fitness
qualification (Attach 3) and the privacy form (Attach 4), the athlete will not
be allowed to take part to the I ANDORRA
BWMF CUP 2013.
If
you do not sign the Parental permission for use of child's image (Attach 4),
the image of the child will not be published in the Tournament brochure.
Name:
Signature:
Date:
___________________________
President or Secretary of the Club
ENTRY FEE before 1ST APRIL 2013
50% OF THE PARTICIPATION
FEE before 15TH
APRIL 2013
FULL
PAYMENT before 1 ST JUNE 2013