Entry Form for Competitors of Foreign Countries only (Entry NED Participants see Announcement)
9th Masters' International Speed Skating LONG DISTANCE RACES, Heerenveen/NED, Monday 26 Mar 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 Thursday 01 Mar 2012 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.schaatscircuit.nl.
 

Family name

First name

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

Email address

Telephone

Cellphone

Telefax

Male/female

Date of birth

Starting for nation

National license no.

Club

 
500 m and only one long distance allowed. Long distance chosen:

Insert one long distance
from 3.000 m or 5.000 m or 10.000 m

Your corresponding best time(s) must be quoted because of seeding. If no time is achieved this season, quote your best time previous season; if not available, quote etimated time:

Time 500 m

Time long distance chosen

Remarks

Payment Entrance Fee:
To get registered, the Entrance Fee (30 EUR, 35 EUR or 45 EUR per participant, see announcement) has to be remitted to the following account up to the 29 February 2012:
MCLN, Rabo Bank Mijdrecht, Account-No. 1952.05.111,
IBAN: NL04 RABO 0195 2051 11, BIC-/SWIFT-Code: RABONL2U.
Under concern please enter the "name of the competitor" and "9th Heerenveen LDR 2012".
Waiver:
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 9th Masters International Speed Skating LONG DISTANCE RACES 2012 in Heerenveen/The Netherlands. 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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