Entry Form
4th Masters' International Speed Skating CANADIAN OPEN, Fort St. John/CANADA, 04 - 05 Feb 2012
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 Monday 16 Jan 2012 at the latest, now extended to Saturday 21 Jan 2012.
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.fsjspeedskating.com

Last name

First name

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

Email address





Date of birth

Starting for nation

National license no.



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 4th Masters International Speed Skating CANADIAN OPEN 2012 in Fort St. John/Canada. 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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