Para Dance Sport Polish Open

Lomianki 7-9 June 2024

ENTRY FORM

Couple/Single	Partner / Man		Partner / Lady
Surname / Name
Date of birth dd/mm/year
Combi Standard
Combi Latin
Duo Standard
Duo Latin
Single Conventional
Juniors Single
Combi Freestyle
Duo Freestyle
Single Freestyle
Class 1-2 (please, indicate)
Wheelchair user (please, indicate who)
SDMS License number
STAFF coaches, supporters:
TRAVEL INFORMATION:
NPC:
Contact person:
Tel.		E-mail:

Amateur Declaration Statement:

An athlete is eligible to compete in World Para Dance Sport only if he or she is not a National coach in WDS, team leader,

coach or representative of a national team, adjudicator, standing dancer from the Professional Division in Dance Sport.

“According to the clause 3.3 of the 2018 WPDS Rules and Regulations, I declare I am eligible to compete in Para Dance

Sport”.

Athletes’ signature:

Date:

Signature and stamp

National Paralympic Committee or relevant organization, endorsed by NPC.

The Entry Form should be sent by e-mail no later than 10 May 2024.

iciok@wp.pl and info@worldparadancesport.org