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federazione italiana sport paralimpici degli intellettivo relazionali ENTRY BY NAMES FORM Country

SU-DS Date of Birth Passport/ID Card T-shirt Gender Role Registration no. (DD/MM/YYYY) No. size federazione italiana sport paralimpici degli intellettivo relazionali ENTRY BY NAMES FORM Country

SU-DS Date of Birth Passport/ID Card T-shirt Surname Given Name Gender Role Registration no. (DD/MM/YYYY) No. size federazione italiana sport paralimpici degli intellettivo relazionali ENTRY BY NAMES FORM Country

SU-DS Date of Birth Passport/ID Card T-shirt Surname Given Name Gender Role Registration no. (DD/MM/YYYY) No. size

If you need to fill more copies of this form, please name them [country]_bynumbers_1, [country]_bynumbers_2 etc.

Please return this form by 15 July 2021 by email to [email protected]. Do NOT print and fill this form by pen or pencil; we will only accept electronically filled copies federazione italiana sport paralimpici degli intellettivo relazionali

TRAVEL INFORMATION FORM

Country/Delegation

Chosen Mean of Transport Plane Train Bus/Private Car

Point of Entry Bologna Airport Ferrara Train St. Other

Do you require a wheelchair accessible bus? Yes No

Please note that transportation to and from the point of entry is included in the accommodation package price only for arrivals into Bologna Airport and Ferrara Train Station.

FLIGHT/TRAIN INFO

Arrival

Date Flight/Train No. Time

Arriving from

Departure

Date Flight/Train No. Time

Leaving from Destination

Travel Info Form Page no. 1 of 1 ATHLETICS COMPETITION FORM

federazione italiana sport paralimpici Country degli intellettivo relazionali

Minimums must be in 00.00 or 00.00.00 format for times and in 00.00 format for lengths; do not add the unit of measurement.

If a competition does NOT have a minimum, please write “X” or “Yes” in the relevant column relay relay 100 m 800 m 800 m 200 m 400 m Discus SU-DS Date of Birth 1500 m 1500 m Javelin 4x100 m Shot put Shot 4x400 m Triathlon

Surname Given Name Gender T21/M walk race walk race Registration no. (DD/MM/YYYY) jump

TEAM STAFF Surname Given Name Gender DOB (DD/MM/YYYY) Position/Role

Please return this form by 15 July 2021 by email to [email protected]. Do NOT print and fill this form by pen or pencil; we will only accept electronically filled copies federazione italiana sport paralimpici degli intellettivo relazionali 4X4 BASKETBALL COMPETITION FORM

Country

Players

SU-DS Surname Name Date of Birth Gender T21/Mos. (DD/MM/YYYY) (M/F) Reg. no.

Team Staff

Surname Name Gender Role/Position (M/F) federazione italiana sport paralimpici degli intellettivo relazionali FUTSAL COMPETITION FORM

Country

Players

SU-DS Surname Name Date of Birth Gender T21/Mos. (DD/MM/YYYY) (M/F) Reg. no.

Team Staff

Surname Name Gender Role/Position (M/F) federazione italiana sport paralimpici degli intellettivo relazionali JUDO COMPETITION FORM

Country

Judoka

SU-DS Surname Name Date of Birth Gender T21/Mos. Weight (DD/MM/YYYY) (M/F) Reg. no. (Kg)

Team Staff

Surname Name Gender Role/Position (M/F) SWIMMING COMPETITION FORM - INDIVIDUAL RACES

federazione italiana sport paralimpici Country degli intellettivo relazionali

Minimums must be in 00.00 or 00.00.00 format for times; do not add the unit of measurement. Individual Freestyle Backstroke Breaststroke Butterfly If a competition does NOT have a minimum, please write “X” or “Yes” in the relevant column. Medleys The Team Staff section on page 2 is valid for both the individual races and the relays.

SU-DS Year of 25 m 25 m 25 m 25 m 50 m 50 m 50 m 50 m 100 m 100 m 100 m 100 m 100 m 800 m 200 m 200 m 200 m 200 m 200 m 400 m Surname Given Name M/F T21/M 400 m Reg. no. Birth 1500 m

Please return this form by 15 July 2021 by email to [email protected]. Do NOT print and fill this form by pen or pencil; we will only accept electronically filled copies SWIMMING COMPETITION FORM - TEAM STAFF

federazione italiana sport paralimpici Country degli intellettivo relazionali

Surname Name Gender Date of Birth Role/Position (DD/MM/YYYY)

Please return this form by 15 July 2021 by email to [email protected]. Do NOT print and fill this form by pen or pencil; we will only accept electronically filled copies SWIMMING COMPETITION FORM - RELAYS

federazione italiana sport paralimpici Country degli intellettivo relazionali

4x50 m Freestyle - MALE 4x50 m Freestyle - FEMALE

SU-DS Date of Birth SU-DS Date of Birth # Surname Given Name T21/M # Surname Given Name T21/M Registration no. (DD/MM/YYYY) Registration no. (DD/MM/YYYY)

1 1

2 2

3 3

4 4

R R

R R

4x100 m Freestyle - MALE 4x100 m Freestyle - FEMALE

SU-DS Date of Birth SU-DS Date of Birth # Surname Given Name T21/M # Surname Given Name T21/M Registration no. (DD/MM/YYYY) Registration no. (DD/MM/YYYY)

1 1

2 2

3 3

4 4

R R

R R

4x200 m Freestyle - MALE 4x200 m Freestyle - FEMALE

SU-DS Date of Birth SU-DS Date of Birth # Surname Given Name T21/M # Surname Given Name T21/M Registration no. (DD/MM/YYYY) Registration no. (DD/MM/YYYY)

1 1

2 2

3 3

4 4

R R

R R

Please return this form by 15 July 2021 by email to [email protected]. Do NOT print and fill this form by pen or pencil; we will only accept electronically filled copies SWIMMING COMPETITION FORM - RELAYS

federazione italiana sport paralimpici Country degli intellettivo relazionali

4x50 m Medley - MALE 4x50 m Medley - FEMALE

SU-DS Date of Birth SU-DS Date of Birth # Surname Given Name T21/M # Surname Given Name T21/M Registration no. (DD/MM/YYYY) Registration no. (DD/MM/YYYY)

1 1

2 2

3 3

4 4

R R

R R

4x100 m Medley - MALE 4x100 m Medley - FEMALE

SU-DS Date of Birth SU-DS Date of Birth # Surname Given Name T21/M # Surname Given Name T21/M Registration no. (DD/MM/YYYY) Registration no. (DD/MM/YYYY)

1 1

2 2

3 3

4 4

R R

R R

4x100 m Freestyle - MIXED 4x100 m Medley - MIXED

SU-DS Date of Birth SU-DS Date of Birth # Surname Given Name M/F T21/M # Surname Given Name M/F T21/M Reg. no. (DD/MM/YYYY) Reg. no. (DD/MM/YYYY)

1 1

2 2

3 3

4 4

R R

R R

Please return this form by 15 July 2021 by email to [email protected]. Do NOT print and fill this form by pen or pencil; we will only accept electronically filled copies federazione italiana sport paralimpici degli intellettivo relazionali

SYNCHRONIZED SWIMMING COMPETITION FORM Country

Solo Tech

SU-DS Surname Name Date of Birth Gender T21/Mos. (DD/MM/YYYY) (M/F) Reg. no.

Solo Free

SU-DS Surname Name Date of Birth Gender T21/Mos. (DD/MM/YYYY) (M/F) Reg. no.

Duet Tech

SU-DS Surname Name Date of Birth Gender T21/Mos. # (DD/MM/YYYY) (M/F) Reg. no.

1

2

Duet Free

SU-DS Surname Name Date of Birth Gender T21/Mos. # (DD/MM/YYYY) (M/F) Reg. no.

1

2

Synchronized Swimming Form Page no. 1 of 2 federazione italiana sport paralimpici degli intellettivo relazionali

SYNCHRONIZED SWIMMING COMPETITION FORM Country

Team Tech

SU-DS Surname Name Date of Birth Gender T21/Mos. (DD/MM/YYYY) (M/F) Reg. no.

Team Staff

Surname Name Date of Birth Gender Role/Position (DD/MM/YYYY) (M/F)

Synch. Swimming Form Synchronized Swimming Form Page no. 2 of 2 Page no. 2 of 2 federazione italiana sport paralimpici degli intellettivo relazionali TENNIS COMPETITION FORM Country

SU-DS Date of Birth Mixed Surname Given Name Gender T21/M Singles Doubles Registration no. (DD/MM/YYYY) Doubles

Please fill in the Team Staff section on page 2 federazione italiana sport paralimpici degli intellettivo relazionali TENNIS COMPETITION FORM Country

TEAM STAFF

Date of Birth Surname Given Name Gender Role/Position (DD/MM/YYYY) federazione italiana sport paralimpici degli intellettivo relazionali TABLE TENNIS COMPETITION FORM Country

SU-DS Date of Birth Mixed Surname Given Name Gender T21/M Singles Doubles Team Registration no. (DD/MM/YYYY) Doubles

Please fill in the Team Staff section on page 2 federazione italiana sport paralimpici degli intellettivo relazionali TABLE TENNIS COMPETITION FORM Country

TEAM STAFF

Date of Birth Surname Given Name Gender Role/Position (DD/MM/YYYY)