INSCRIPTION

                                                                                                                                                                                                                                                                

ENTRY FORM


Name of the Club:

Address of the Club:

Contact Person:

Phone number:

Fax:
E-mail:



We will participate in the following category (please cross clearly with X):



First Category (born 2000 and younger)


Second Category (born 1998 and younger)

  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If you do not sign the Parental permission for use of child's image (Attach 4), the image of the child will not be published in the Tournament brochure.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