Entry Form
LA PATAGONES- VIEDMA | FINA 10K Marathon Swimming  World Cup 2014
Saturday, February 1st, 2014
Phone: +54 2920 42-7540
E-mail: lapatagonesviedma@noticiasnet.com.ar - nadoplit@hotmail.com
*Country:
Office Use:
*Photo:
* The image file can be in .Jpg,. Gif,. Bmp format and should not exceed 200kb
SWIMMER
*Family Name:
*Address:
*Height (cm)
School/Univ:
Club Name:
*Given name:
*Home Town:
*Date of Birth:
*Passport:
Pers. Coach:
*Gender:
*Weight (kg):
Occupation:
*E-mail:
*Nationality:
PERFORMANCES
Event name:
Personal Best Performances:
(time, year, place & competition)
We verify that this athlete is a member in good standing of FINA affiliated Federation | President/Secretary of Federation
*Date:
*Stap:
*Name:
*Signature:
Declaration:

Release form Liability: I here by declare that I exonerate from all liability and responsibility however so arising, FINA, its affiliates, the Hosting National Federation Organising Committee and staff, and the venue owners, Sponsors, and any other persons that participate in the Championships, in respect to all and every action or claim about accidents that may occur (except liability and responsibility for personal injury or death caused due to the neglicence of those respective bodies or persons).

Doping ControlAuthorization: I agree to participate, if selected in random drug testing including blood testing at any time, either in or out of competition, as organized by FINA, I also agree that the FINARules, related to doping control and drug testing shall be effective to me personally.

Transfer of Rights: Understanding as a competitor in the La Patagones-Viedma Fina 10km Marathon Swimming World Cup, the importance for FINA of keeping all filming, television, photographing and all other recording rights during the Championships (or Competitions, Tournament, Cups, etc.). I, in consideration of the acceptance ofmy participation in the Championships, agree to be filmed, televised, photographed and otherwise recorded during the Championships under conditions and for the purposes now and hereafter authorized by FINAin relation to the promotion of the Championships and the Sports of Swimming.

Permission of Photo Use: I agree that the Organizing Committee usesmy photo affixed to this form as a photo forAccreditation Card as well as for establishing of athlete profile for presentation at the Championships. If being under age on the first day of the Championships I am entering, I wishmy parent or guardian to sign this statement onmy behalf.

© 2008 FINA. All Rights reserved

TOTAL CASH PURSE: US$ 20,000.00