Bulletin d'inscription Laser RC Nationale 2014 ENG

FÉDÉRATION FRANCAISE DE VOILE
COUPE NATIONALE LASER RC
13 - 14 September 2014
CERCLE DE VOILE DE VALENCIENNES
ENTRY FORM
Skipper
Name

First name :

Date of Birth
Club
Address
Postcode and City
E-mail

@
Sail No.

Hull No.

Frequency 1

Frequency 3

Frequency 2

(Min 3 if not 2.4 Ghz)

Please return the entry form to:
Via Post : Pierre Parent, 607 avenue de la république, 59000 Lille (France)
or
Via E-mail : cvvvrc@gmail.com
Each entry must include a proof of payment of registration fee and meal expenses.
Cheques must be made payable to CVV.
Entry fee: 20€, net of banking charges (25€ after the 1st September 2014).
Meal reservation – Coupe Nationale Laser RC
Skippers’
dinner (25€)

Lunch
(11€)
13/09/14
14/09/14

Please indicate the number of meals

No of meals
No of meals x price

€

€

€

Total :

No meal reservation will be taken into account without payment.

To be paid
Registration fee

€

Meals (total 1)

€

TOTAL:

€

Payable to CVV

By registering, the signatory agrees:
- to abide to Racing Rules of sailing and all other conditions covering this event

- to authorise shots and photos to be taken of the boat and her skipper (on land and in the
water) and their name and pictures to be used, exploited, reproduced, exploited on all
media by the organiser, partners, FFVoile and/or authorised cameramen and
photographers and any authorised person.
Signature of the skipper preceded by the handwritten words “Read and approved”

PARENTS’ CONSENT: (Mandatory for skippers under 18)
I the undersigned hereby certify (Name, First name) that:
- I have full parental authority (delete as appropriate)
YES

NO

- I am the legal guardian (delete as appropriate)
YES

NO

of the underage skipper: (Name, First name)
- I authorise the above-mentioned is underage person to take part in the Coupe
Nationale de la classe Laser RC organised by the Cercle de Voile de Valenciennes
from 13 to 14 September 2014
- In case of emergency, I authorise any medical procedures and medical care,
including transportation to a hospital.
Signature of the legal representative preceded by the handwritten words “Read and
approved”

MEDIA INFORMATION:
Skipper’s record