Definitive entry FIAC 2012

6-7-8 April 2012 Logo

Club - Federation

Name of club or federation *

Contactperson

First Name *

Name *

Phone

Mobile

Email address *

Definitive entries

Delegation information

Head of delegation

Team Manager

Number of coaches

Number of judges

Number of additional visitors

Age Group

AG WP:

AG WG:

AG MP:

AG MXP:

AG MG:

Juniors

JUN WP:

JUN WG:

JUN MP:

JUN MXP:

JUN MG:

Seniors

SEN WP:

SEN WG:

SEN MP:

SEN MXP:

SEN MG:

I level

I1 Pair:

I1 Group:

I2 Pair:

I2 Group:

B-level

B jun Pair:

B jun Group:

B sen Pair:

B sen Group:

Way of travel

Indicate your way of travel: *
Private
Flight (to a Belgian airport)
Train (to Brussels Zuid/Midi station)

Entry fee

I/B level: gymnasts x €15

Age Group: gymnasts x €20

Junior: gymnasts x €30

Senior: gymnasts x €40

Total entry fee:€

Hotel reservation

Please fill in the number of persons per roomtype!

Single room: persons x €105

Double room: persons x €85

Triple room: persons x €75

Number of nights:

Total accommodation:€

Payment (more info: see invitation)

To be paid before February 15th 2012: € (= Total entry fee + 50% accommodation)

Remark: the total amount shown is based on standard bookings. This means, in order to simplify the form, all persons stay the same number of nights etc. The real amount may therefore be different! The "no judge fee" is also not included in this calculation.

T-Shirts (only for gymnasts and coaches !!)

Size

140cm

152cm

164cm

176cm

--S--

--M--

--L--

--XL--

--XXL--

Remarks and additional info

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