11th FORMULA DE Masters November 9 & 10, 2002 ENROLLMENT FORM for up to 3 players. . Fill out this form using CAPITAL letters. . Check “female” and give your birth day if you wish to be included in specific rankings . Mail this form, together with your check(s) to : Association Ludo Lieusaint – Masters Formule Dé 50, rue de Paris – 77127 Lieusaint - FRANCE . To enroll more than 3 players, make copies of this form and mail them back together. . For more information, email
[email protected] or call +33 1 64 13 92 58.
TYPE OF ENROLLMENT
! TEAM
TEAM NAME : ……………………………………………….
• A Team is 3 players exactly. All 3 players in a team must enroll on the same form
__________ OR _________
! INDIVIDUAL PLAYER(S) • A “meeting space” will be available Saturday morning to help individual players get together and form teams.
Primary Player (will receive tournament documents for all players on this form)
!
Nickname (driver’s name) : : ................................................ Date of birth : _ _ /_ _ /_ _ _ _ Female : Last name : ................................................... First name : ..................................................................................... Address : ................................................................................................................................................................ ................................................................................................................................................................. City : ................................................... Zip Code :............................ Country : ...................................... League : ........................................ e-mail : ....................................................... Tel. :..............................
Other participants:
!
Nickname (driver’s name) : : ................................................ Date of birth : _ _ /_ _ /_ _ _ _ Female : Last name : ................................................... First name : ..................................................................................... Address : ................................................................................................................................................................ City : ................................................... Zip Code :............................ Country : ...................................... League : ........................................ e-mail : ....................................................... Tel. :..............................
!
Nickname (driver’s name) : : ................................................ Date of birth : _ _ /_ _ /_ _ _ _ Female : Last name : ................................................... First name : ..................................................................................... Address : ................................................................................................................................................................ City : ................................................... Zip Code :............................ Country : ...................................... League : ........................................ e-mail : ....................................................... Tel. :..............................
PAYMENT
. Cost : 20 €uros per player before November 1st, 2003. 25 €uros thereafter. for a team, that’s 60 €uros before November 1st, 2003 or 75 €uros thereafter. . Write your check to the order of «Association Ludo Lieusaint».
Total amount paid : ……… €uros Number of checks included : …. Date :……………..…..
Primary player’s signature :
