Futsal Totally Blind Soccer Ball

ASSOCIAZIONE SPORTIVA CULTURALE SALENTINA DELL’UNIONE DEI CIECHI E DEGLI IPOVEDENTI DI LECCE

PIAZZA PERUZZI 1 – 73100 LECCE

TEL. + 39 320/7216765 fax: + 39 0832/241212

mail:

APULIA TOURNAMENT2015

Futsal totally blind soccer ball

LECCE 19th– 21stJune

Registration form

General Information:

Company name: ______Nationality______

Address______Contact person______

Telephone number ______fax number ______e-mail______

Spoken language:______

About the team:

Sports you are involved in______

Competing athletes’ disability: Totally blind YES NO valid medical certificate YES NO

At which level do you play futsal blind soccer ball?______

In which championship do you play?______

Have you taken part in International meetings? YES NO which one/s?______.

Logistics/ Team composition:

Country you are leaving from______,

Arrival airport Bari Palese/BrindisiPapolaCasale, arrival date ______

Flight number______company______;

Departure airport Bari Palese/BrindisiPapolaCasale, departure date ______

Flight number______company ______.

Number of team members:

Athletes______

Partners______

Coach______

Guides/Goalkeepers______

Hotel accomodation:

The full board accomodationfor participating teams will totally be on the premises of the organizing company at the hotel inside the Institute for the blind “Anna Antonacci”.

The organizing company will pay any costs concerning room and boardfor 14 members of each team; for any additional member, we will offer you the best quotation in order to grant you the best service.

Room and board will be paid for from June 19th to June 21st; every exception will have to be discussed when filling this form.

Please, inform us as soon as possible about any particular needs or details concerning the stay of both managers and athletes.

Useful details:

Our company will pay for all costs deriving from the team transfer during all tournament steps; as indicated before, the costs for the flight to the nearest airport are excluded.

The whole tournament will be organized according to the rules both of the Italian Federation of Paralimpic Sports for Visually Impaired and of IBSA; during the stay, logistical and medical support for any needs of managers and athletes will be granted.

The tournament will be held in a federally approved sports centre which will grant the correct carrying out of each stage.

This form must be undersigned in order to confirm the participation in the tournament no later than April 15th 2015. To protect the interests of the organizing company, when registering, each participating team has to pay € 250,00 as a deposit, which will be given back when the teams will get to the hotel; the participating team has the right to give the participation up no later than May 15th 2015; after this date, the organizing companyreserves the right to keep the deposit, in order to cover the booking costs.

During the different stages of the tournament, the organizing company will grant the presence ofan interpreter.

Contactperson:

Antonio Potenza mobile: + 39 320/7216765 fax: + 39 0832/241212 e-mail:

Piazza Peruzzi 1 – 73100 Lecce

Signature