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c/o Karin Kaspar,
Dorfstr. 6,
17406 Grüssow

Fon 03 83 72/ 70 803
Fax 03 83 72/ 76 930

info@usedomer-achterland.de

Aplication form

7th Festival of Swimming
for the trophy Septembre 7th 2008

Long distance about 4 km                                                           Short distance 2 km

distance for everyone, 6 – 60 years, 800 m   

Name:                Christian name:                               

Date of birth:                     Street/Nr :

Postcode / city:

Phone/Fax                E-mail:

(please fill in with block letter, if you send it by your own by fax or post)

You also have the option of registering either via e-mail or through our club homepage: www.usedomer-achterland.de or www.drk-ovp.de. You will receive confirmation of registration via e-mail.

I declare that I’m fit for swimming and healthy enough to swim those distances. I will start on my own risk.

Name:                Christian name:     

Name and surname of legal guardian / parent:            

                         
 
Date/Signature                                                                               Signature of parents or responsible person when starter younger than 18 years

                                

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