Application Form - International Athletes Licence - 2012

International Athlete License 2011 tel. +39 11 tel. 3853995 +39 . Switzerland . Italy . Country: OtherTel. GivenName: Date Birth of(d/m/y): 3001 Bern 3001 . e-mail: [email protected] e-mail:

. Torino10141 . Effingerstrasse1 www.ifsc-climbing.org :

web Office: Corso 122Ferrucci ...... …………………………………………… …………………………………………… E-mail: (with international(with code) City: Cell / Mobile Tel.: Sex: Address: Surname: COMPETITOR FEDERATION COUNTRY ADDRESS APPLICATION FORMAPPLICATION INTERNATIONAL - ATHLETES 2012- LICENCE International Athlete License 2011 the IFSC

. Date:...... Date:...... tel. +39 11 tel. 3853995 +39 . Switzerland . Italy . 3001 Bern 3001 . e-mail: [email protected] e-mail:

. Torino10141 . Effingerstrasse1 www.ifsc-climbing.org : web Office: Corso 122Ferrucci publish publish or any disciplinaryappeal concerningme on decision (including its website). record my image by any types of equipment (video, photo etc.) and use it for any purpose in connectionto relationand in interests the sports with of climbing my address e-mailtoUse send me and IFSC other the newsletterrelated information IFSC disciplinary proceedings in connection with any disciplinary offence (including doping cases) against me. that share information the to WADA and it provideany I withotheranti-doping organisation; present in his body or to reveal the possible use of consentprohibited substancesbeing or methods;valid this for doping tests competitions; in connection with a competition as I expressly acknowledge the right of WADA and anywell other anti-doping organisation to perform as outside out-of-competition tests oninformation; me for I IFSC expressly and acknowledge the to right of provide IFSC all and WADA necessary to start whereabouts or to join as a party in Code of on ConductIntegrity Code Sports of Betting I expressly consent to submit to all methods medical, clinicalof or biological testingtesting for the (blood,purpose of revealing urine,if a prohibited gasessubstance is etc.) and any without questionprotestation without andor exerciseself-restraintat all times; I will refrain from using prohibited substances substancesprohibited andmethods; and methods or encouraging others to use I will treat other competitors, officials and others involved in the practice of the sport with full and due respect at all both during times, and a outside competition. I will not be involved in betting in respect of IFSC competitions and will comply with I understand and abide by the regulations and rules of the sport and observe the principles of good sportsmanship; I will accept, subject to the official appeal procedure, the decisions of the official judges signtogetheror of withtheon athlete) behalf Athlete’s Athlete’s signature: ...... Parent’s/Guardian’ssignature: ...... (ifathleteminor athe has disabilitypreventing is a form,or parent thisto sign ahim/her or guardian shall ...... I agreeI IFSCthemay: that In connectionIn anti-doping:with In particular: In I. I. Competitors Obligations of By applying for an International Licence I acknowledge the rules of IFSC and accordingtothese rules. commit myself to act International Athlete License 2011 Date:...... tel. +39 11 tel. 3853995 +39 . Switzerland . Italy . …………………………………… 3001 Bern 3001 (Seal of the (Seal Federation Signaturethe of and readable ) . e-mail: [email protected] e-mail:

. Torino10141 . Effingerstrasse1 www.ifsc-climbing.org : web Office: Corso 122Ferrucci . practitioner practitioner and declaredfit in to Internationalclimbing competitions. compete to constantly monitor the physical fitness of these competitors, in order that the competitors take do whichnot part in fortheirfitness in competitions isdoubt. to ensure that these competitors are fully andrisks.medical properly insured for personal accident and to inform the IFSC immediately of any adverse analytical athlete disciplinaryand connectionof proceedings in such; with finding from doping tests of any to start on request of IFSC without delay disciplinary proceedings against any competitor who has been subject to an adverse analytical finding from a doping test and to inform keep the informed IFSC fullyany progress suchabout the ofproceedings. to ensure that the competitor has been physically examined by a qualified medical to inform the IFSC immediately any change competitor’softheto IFSC ofthe immediately inform above; givendetails all to providewhereaboutsinformation athletes concerning requestedits byIFSC; Athlete’s Athlete’s signature: ...... Federation’sofficerandin the charge the it reportingcompetitor, was when dates signed. Formssentbye-mailwill afax and/or be considered unofficial as pre-registration. EachFormis to ONE be used for Competitor Only Forms without the seal and the signature of the applying Federation and of the competitors shall not betaken into consideration. Therefore, Forms shall be sent by post only in original (ALL pages), duly sealed and undersigned by the Validityeach of licenceexpires the at endofthe calendar current year. Each year, before the first competition of the season (or before the first competition of the season in which their competitors intend to participate), every Federation shall apply for newrenewalof all ones,in this existing written and form. using licences or for All competitors (including competitions bein must possession an Licenceissuedof International byIFSC. the youth categories competitors) competing in International Those Climbing competitors for whom their Licences, NOT will in be allowed IFSC to approved compete events. belonging Federations have not applied for an International ………………… (Placeanddate) NOTICE IMPORTANT II. Obligations of II.IFSC Member of Obligations Association MemberA competitorsAssociation whose forapplyInternational an undertakes: Licence I haveI to IFSCConduct and theCodeSportsofread agreeBetting on Integrity International Athlete License 2011 tel. +39 11 tel. 3853995 +39 . Switzerland . Italy . 3001 Bern 3001 . e-mail: [email protected] e-mail:

. Torino10141 . Effingerstrasse1 www.ifsc-climbing.org : web Office: Corso 122Ferrucci 2012 - annual licence fee cost 30 €/competitor, for both new and renewed licences. These fees are topaid beupon receivingrelevantthe invoice, season. theat end of the