Entry Form
6th Masters' International Speed Skating REVIVAL, Baselga di Pinč/Italy, 10 - 11 Dez 2011
Please fill in this entry form completely and submit it. It will reach the organizer of the competition very fast.
Only use latin letters. Entry is expected until Friday 04 Dec 2011 at the latest.
You will be informed by email about the arrival of your entry at the organizer. Additionally a list of entries can be found at:  www.icerinkpine.it .

Family name

First name

Complete postal address
(street, no., postal code, town, province, country)

eMail Address





Date of Birth

Starting for nation

National license no.


Number of participants in welcome drink
(inclusive companions)

Number of participants in common supper
(inclusive companions)


I hereby declare, that I am in good health and I am properly conditioned for the competitions. I absolutely relieve the organizer, the ISU, the IMSSC and the IMSSG of any responsibility for any injury, loss or damage to myself or my property or to accompanying persons or their property which may sustain in the course of or in connection with the 6th Masters' International Speed Skating REVIVAL 2011 in Baselga di Pinč/Italy. Included in my declaration is the non-liability of the organizer according to ISU Rule 119, as expressed in the announcement of the competition.

I agree with the waiver  

Several entries:   For sending several entries it may be necessary, not only to press the "Reset"-button and to fill in the form with the data of the following entry and to press again the "Submit"-button, but to reload the entry form for every new entry (depending on the browser used).

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