Entry Form
2nd Masters' International RUSSIAN Speed Skating SINGLE DISTANCE RACES, Kolomna/RUSSIA,
23 - 25 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 Sunday 06 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.rsum.ru .

Family name

First name

Complete Postal Address
(street, nr., postal code, town, province, country)

Email address





Date of birth

Starting for nation

National license no.



Mark the distances you want to race - max. 2 distances per day. Distances:

Friday 500 m (F/M)

Friday 1500 m (F/M)

Friday 5000 m (F/M)

Saturday 1000 m (F/M)

Saturday 1500 m (M)

Saturday 3000 m (F/M)

Saturday 10000 m (M)

Mark the Team Pursuit and/or the Marathon you want to race:

Sunday Pursuit 6 laps (F)

Sunday Pursuit 8 laps (M)

Sunday Marathon 50 laps (F/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:

Best time season 500 m

Best time season 1.000 m

Best time season 1.500 m

Best time season 3.000 m

Best time season 5.000 m

Best time season 10.000 m

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 occur in the course of or in connection with the 2nd Masters' International RUSSIAN Speed Skating SINGLE DISTANCE RACES 2012 in Kolomna/RUSSIA. 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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