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

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 2019