EAP participation request in the EAP meeting

: mandatory field
   1 - DIRECT CONTACT
The Email address where I can be reached
 
Name
 
   2 - PERSONAL DATA
I am
 
Club / Federation / Organization
 
Date of birth
 
citizen of
 
Licence n° (if any)
     
Member of the EAP circuit ?
  Yes No
  3 - EVENTS
I want to compete in the
 
Category
 
Event 1
 
Perf. 1
00.00.00
 
Event 2
    
Perf. 2
00.00.00
    
Event 3
    
Perf. 3
00.00.00
    
Event 4
    
Perf. 4
00.00.00
    
  3a - Additional information on events or Performances
      (PB, results on national, continental or World championships) ?
  4 - HOW TO CONTACT ME
Address where I can be reached
    
This address is
   
Another Email address where I can be reached
    
The phone number where I can be reached
    
Another phone number where I can be reached
    
The fax number where I can be reached
    
Another fax number where I can be reached
    
Other contact number ?
    
  4a - Additional remarks or comments on
         address and contact points ?
  5 - THE EAP POLICY IS TO ENGAGE DRUG-FREE ATHLETES,        EXCLUSIVELY ! Adhere to the EAP Code of Conduct :
Please note: this form is ONLY A PRE-REGISTRATION REQUEST.
The organizer needs to confirm your participation first !

 Do not copy this form without permission

© EAP 2016