VI European Masters Water Polo Championships Hamburg 4 -9 July ...

Named Entry Form
(Form 1-2)
Club Name
Street, Number
Postal Code
City
Country
Phone
Fax
E-Mail
Contact person
Age Group
Team List
Officials
Referee
The Club will participate in the VI European Masters Water Polo Championships in Hamburg 2011, with the following players:
Age as on
Cap Last Name First Name Date of birth 31.12.2011 Passport No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
1
2
3
1
Last Name First Name Date of birth Passport No
Last Name First Name National International
Place & date
Signature
Signature of the President or Secretary of the Club
Signature of the President or Secretary of the Federation
to which the Club is affiliated and stamp of the Federation
Entry deadline: 23 June 2011
Return this form to Organizing Committee by fax to +49 40 69 65 24 57 and to LEN Office in Luxembourg by fax to +352 27 44 91 64 28
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