A.S.D.
world
DanceSport
federation
THE STAR CHAMPIONSHIP
Olga Cacciari & Simone Canè
33° Trofeo Vittorio Colombo
MODULO DI ISCRIZIONE - ENTRY FORM
Trasmettere a: Fabio Temperini - Fax +39 0861 1850582 - E-mail: [email protected] entro le ore 18 dell’11/03/2014
Please, send to: Fabio Temperini - Fax +39 0861 1850582 - E-mail: [email protected] within 6 p.m. 11/03/2014
Si prega di scrivere in stampatello / Please, write in block letters
Cav./Man_____________________________________________________________________________________________________________________________________________
Cognome/Nome - Surname/Name
MIN
Dama/Lady__________________________________________________________________________________________________________________________________________
Cognome/Nome - Surname/Name
MIN
Nazione/Country______________________________________________________ E-mail__________________________________________________________________
PLEASE TICK EVENTS YOU WISH TO ENTER
WDSF Senior III Standard
21 Mar.
th
(escluse le prime 50 coppie in ranking list WDSF)
WDSF Senior IV Standard
WDSF Senior II Latin
22th Mar.
23th Mar.
WDSF Rising Star Amateur Standard
WDSF Rising Star Amateur Latin
(escluse le prime 50 coppie in ranking list WDSF)
WDSF Senior II Standard
WDSF International Open Latin
WDSF Senior I Latin
WDSF Under 21 Standard
WDSF Prof. Master Class I
Open Latin (over 35)
WDSF Prof. Adults Standard (over 18)
WDSF Senior I Standard
WDSF Juveniles 6/11 Latin
WDSF Prof. Master Class I
Open Standard (over 35)
WDSF Prof. Master Class II
Open Standard (over 45)
WDSF Juveniles 6/11 Standard
WDSF International Open Standard
WDSF Junior 12/15 Latin
WDSF Under 21 Latin
WDSF Junior 12/15 Standard
WDSF Prof. Adults Latin (over 18)
QUOTE DI ISCRIZIONE A COPPIA / ADVANCE ENTRY FEES PER COUPLE
Quota unica a coppia per gara WDSF e Professional Division: E 50,00 (only quota)
MODALITA’ DI PAGAMENTO / METHODS OF PAYMENT
- Bollettino di C/C postale n. 1001222528 intestato a “CANE’ SIMONE”. Causale: “33° Trofeo V. Colombo”
oppure / or
- Bonifico bancario IBAN: IT39O0760102400001001222528 - CODICE BIC/SWIFT: BPPIITRRXXX CIN: O - Int.: Canè Simone
Allegare la ricevuta di versamento - Attach your receipt of payment