First Entry Form - Send before September 10

Country

Name of IPC member asocciation

Address

E-mail

Telephone

Fax

Quantity

Wheelchair players

Standing Players

Staff

TOTAL

Responsable person

Charge

Date

Signature

2nd entry form - Send before October 1st

Country

Code

Name of IPC member Assocciation

Address

E-mail

Telephone

Fax

DELEGATION

Athletes

Last name, Name

Class

Standing or Wheelchair?

Team partner name

(same as ITTC Ranking)

("0" if not classified)

("S" o "W")

1

2

3

4

5

6

7

8

9

10

11

12

13

14

15

Staff

Last Name and Name

Delegation Chief

Head Coach

Coach

Coach

Coach

Doctor

Number

Total entry Fee

100u$s of total

Athletes

Staff

TOTAL

We confirm payment of

u$s

to Banco Nación Argentina - Sucursal San Justo

Cuenta número 16097/2 Caja de Ahorro

Argentina

Responsable name

Charge

Date

Airline

Flight Number

Day and Time (Arg.)

Arrival Flight

Arrive to Argentina

Departure Flight

Departure from Argentina

Extra days

Signature