LAST UPDATED ON Friday October 31 2003

Meets

Coach Registration / Accreditation des Entraineurs

2000 Canadian Junior Track & Field Championships

Entry Form

Montreal, Quebec

14-16 juillet 2000

Cost/Cout: $15

(Coach Registration Package includes one meet pass, all documentation necessary for Technical meeting, and results.)
(La trousse diaccrEditation comprend un laissez-passer, toute l'information necessaire pour la REunion technique et les resultats)

Name/NOM First/ Prenom_______________________________________

_____________________________________________________________
Address/Adresse: # Street/rue Apt./App#

_____________________________________________________________
City/ville Province/ Postal Code

Telephone#____________________(work)

Telephone#____________________(home)

Fax#____________________

E-mail address____________________

FORM OF PAYMENT____________________

Please return with Athlete Entry Forms before deadline (Friday July 7, 2000) to:

Ce formulaire devrait accompagner les formulaires des athlEetes, avant la date limite

( vendredi, le 7 juillet,2000): Federation Quebecoise d'Athletisme National Junior Champ./Champ. Canadien Junior 4545 Pierre de Coubertin C.P.1000, Station M Montreal, QuE. H1V 3R2
E-mail/courriel: HYPERLINK mailto:fqa@athletisme.qc.ca Tel: (514) 252-3041 Fax: (514) 252-3042

Office use only
Payment received ($)
Name

Entry Form

2000 Athletics Canada Junior Championships

Male/ Homme Female/Femme

LAST NAME/NOM:

FIRST/PRENOM:

BRANCH:

MEMBERSHIP/REGISTRATION #:

DATE OF BIRTH/NAISSANCE:

Day/Jour Month/Mois Year/Annee


MEDICAL INSURANCE NUMBER:

TELEPHONE:

Day/ Jour Night/Soir E-MAIL

ADDRESS/ADRESSE

# Street/ rue Apt./ App #

City/ville Province Postal Code/Postal

CLUB:

COACH/ENTRAINEUR:

COACH / ENTRAINEUR - TELEPHONE

Day/Jour Night / Soir

EVENT/EPREUVEENTRY STANDARDPERFORMANCEMEET/DATE/LOCATION


CHAMPIONSHIP FEES: ENTRY DEADLINE IS FRIDAY AUGUST 4TH, 2000

1ST Event (Late Entry) Subsequent Event (LateEntry)

$50.00 ($120.00) $45.00 ($105.00)

Make Cheque or Money Order payable to: to/Faire chEeque ou mandat-poste *:

Federation QuebEcoise d'Athletisme 4545 Pierre de Coubertin C.P. 1000, Station M MontrEal, QuE. H1V 3R2 TEL: (514) 252-3041 Fax: (514) 2523042 E-mail/Courriel: HYPERLINK mailto:fqa@athletisme.qc.ca fqa@athletisme.qc.ca Confirmation is the responsibility of the athlete./La confirmation d'inscription est la responsabilitE de l'athlete.

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