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Entry Form 7-th International Masters' EVGUENY GRISHIN Speed Skating MEMORIAL Moscow/Russia,
31 March -- 1 April 2012 Entry is expected until 1 March 2012, at the latest! Please send the entry by fax or
email to: Mrs.Yulia Mitrofanova, Icehall "Krylatskoye", Tel./Fax:
007 499 141 73 51, Email: djan70@mail.ru Family Name:..........................................
First Name:..................
Complete Address (street/no./postal code/town/province/country): …………………………………………………………………………………… …………………………………………………………………………………… Telephone:
Telefax:
eMail:....................................................
Date of
birth:................................. Male/Female:......................................... Starting for Nation:......................
License
Nr.:..........................................
Club:.............................................
Reservation
of the
hotel--------------------------------------------------------------------- I need a Personal Invitation for getting a visa:
yes
no Waiver I hereby declare, that I am in good health
and I am properly conditioned for the competitions. I absolutely relieve Date: Signature: |