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5 ENTRY FORM by NAME Ok.Pdf 30 th Asian Cycling Championships 17 th Asian Junior Cycling Championships 8 - 17 April 2010, UAE ENTRY FORM BY NAME th 1. This Forms must be sent back to UAE Cycling Federation by 7 March 2010 to confirm your participation, along with 4 passport size recent photographs/white background, for each participants and officials, (write the names on back side). Forms received late will not be accepted. ELITE MEN Name of Federation : Address : Tel No. Fax No. E-Mail : UCI CODE/ EVENT SURNAME FIRST NAME PASSPORT No. LICENCE No. Sprint Time Trial (not likely to be held) Team Pursuit Keirin Team Sprint Individual Pursuit Point Race 1/8 30 th Asian Cycling Championships 17 th Asian Junior Cycling Championships 8 - 17 April 2010, UAE ENTRY FORM BY NAME UCI CODE/ EVENT SURNAME FIRST NAME PASSPORT No. LICENCE No. Madison Scratch Omnium Individual Road Race Individual Time Trial Name of Federation : Name of President/Secretary General: Signature and Stamp : Date and Place : 2/8 Page 2 of 9 30 th Asian Cycling Championships 17 th Asian Junior Cycling Championships 8 - 17 April 2010, UAE ENTRY FORM BY NAME th 1. This Forms must be sent back to UAE Cycling Federation by 7 March 2010 to confirm your participation, along with 4 passport size recent photographs/white background, for each participants and officials, (write the names on back side). Forms received late will not be accepted. JUNIOR BOYS Name of Federation : Address : Tel No. Fax No. E-Mail : UCI CODE/ EVENT SURNAME FIRST NAME PASSPORT No. LICENCE No. Sprint Time Trial (not likely to be held) Team Pursuit Keirin Team Sprint Individual Pursuit Point Race 3/8 Page 3 of 9 30 th Asian Cycling Championships 17 th Asian Junior Cycling Championships 8 - 17 April 2010, UAE ENTRY FORM BY NAME UCI CODE/ EVENT SURNAME FIRST NAME PASSPORT No. LICENCE No. Scratch Individual Road Race Individual Time Trial Name of Federation : Name of President/Secretary General: Signature and Stamp : Date and Place : 4/8 Page 4 of 9 30 th Asian Cycling Championships 17 th Asian Junior Cycling Championships 8 - 17 April 2010, UAE ENTRY FORM BY NAME th 1. This Forms must be sent back to UAE Cycling Federation 7 March 2010 to confirm your participation, along with 4 passport size recent photographs/white background, for each participants and officials, (write the names on back side). Forms received late will not be accepted. ELITE WOMEN Name of Federation : Address : Tel No. Fax No. E-Mail : UCI COD E/ EVENT SURNAME FIRST NAME PASSPORT No. LICENCE No. Sprint Time Trial (not likely to be held) Team Pursuit Team Sprint Individual Pursuit Point Race 5/8 Page 5 of 9 30 th Asian Cycling Championships 17 th Asian Junior Cycling Championships 8 - 17 April 2010, UAE ENTRY FORM BY NAME UCI CODE/ EVENT SURNAME FIRST NAME PASSPORT No. LICENCE No. Scratch Omnium Individual Road Race Individual Time Trial Name of Federation : Name of President/Secretary General: Signature and Stamp : Date and Place : 6/8 Page 6 of 9 30 th Asian Cycling Championships 17 th Asian Junior Cycling Championships 8 - 17 April 2010, UAE ENTRY FORM BY NAME th 1. This Forms must be sent back to UAE Cycling Federation by 7 March 2010 to confirm your participation, along with 4 passport size recent photographs/white background, for each participants and officials, (write the names on back side). Forms received late will not be accepted. JUNIOR GIRLS Name of Federation : Address : Tel No. Fax No. E-Mail : UCI CODE/ EVENT SURNAME FIRST NAME PASSPORT No. LICENCE No. Sprint Time Trial (not likely to be held) Team Pursuit Team Sprint Individual Pursuit Point Race 7/8 Page 7 of 9 30 th Asian Cycling Championships 17 th Asian Junior Cycling Championships 8 - 17 April 2010, UAE ENTRY FORM BY NAME UCI CODE/ EVENT SURNAME FIRST NAME PASSPORT No. LICENCE No. Scratch Individual Road Race Individual Time Trial Name of Federation : Name of President/Secretary General: Signature and Stamp : Date and Place : 8/8 Page 8 of 9 30 th Asian Cycling Championships 17 th Asian Junior Cycling Championships 8 - 17 April 2010, UAE ENTRY FORM BY NAME th 1. This Forms must be sent back to UAE Cycling Federation by 7 March 2010 to confirm your participation, along with 4 passport size recent photographs/white background, for each participants and officials, (write the names on back side). Forms received late will not be accepted. OFFICIALS Name of Feder ation : Address : Tel No. : Fax No. : E-Mail : Title SURNAME FIRST NAME Gender (M/F) PASSPORT No. Chief/Deputy Chief of the Delegation Team Manager Coach Mechanic Doctor Masseur Interpreter Others Name of Federation : Name of President/Secretary General: Signature and Stamp : Date and Place : Page 9 of 9 .
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