Preliminary Application for participation in the World Championship - 2013

Preliminary Application
for participation in the rock class of the World Championship on
29th September – 8th October, 2013, Ukraine, Crimea

  1. Country ____________________________________________________.
  2. Full name of the organization (Federation/club) _________________
  3. ___________________________________________________________

  4. Number of teams:
  5. Male _______________________
    Female _______________________

  6. Contact information:
  7. tel/fax ______________________
    e-mail ________________________
    Skype ______________________________
    address ______________________________________________________
    contact person _____________________________________________
    date _________________
    Organizer ____________________  /______________/
                                    (Signature)                                   (Name)