If you need a visa support. Provide this is information to each participant

International Tournament on Pencak Silat

“Open Uzbekistan 2013”

 

ENTRY BY NAME

COUNTRY / STATE: ­­­­­­____________________________________

No.	Participant Name	Passport No.	Date of Birth	Sex	Function / Category

TO BE SUBMITTED LATEST BY 10^ST August 2013 TOGETHER WITH 2 PASSPORT SIZE PHOTOGRAPH (pls write name and function behind the photo)

	_______________________ Name / Designation		_____________________________ Signature / Federation Stamp		__________________ Date

 

 

 

ENTRY BY NUMBER 17-40

 

COUNTRY / STATE: ­­­­­­____________________________________

 

No.	Function	Category / Function	Entry by Number
	Team Manager
	Asst. Team Manager
	Coach
	Coach
	Coach
	Extra Official
	Match Male	Class ‘A’ (Above 45 – 50 kg)
		Class ‘B’ (Above 50 – 55 kg)
		Class ‘C’ (Above 55 – 60 kg)
		Class ‘D’ (Above 60 – 65 kg)
		Class ‘E’ (Above 65 – 70 kg)
		Class ‘F’ (Above 70 – 75 kg)
		Class ‘G’ (Above 75 – 80 kg)
		Class ‘H’ (Above 80 – 85 kg)
		Class ‘I’ (Above 85 – 90 kg)
		Class ‘J’ (Above 90 – 95 kg)
		Class ‘OPEN’ (Above 95 kg)
	Male Artistic	‘Single’
	Female Match	Class ‘A’ (Above 45 – 50 kg)
		Class ‘B’ (Above 50 – 55 kg)
		Class ‘C’ (Above 55 – 60 kg)
		Class ‘D’ (Above 60 – 65 kg)
		Class ‘E’ (Above 65 – 70 kg)
		Class ‘F’ (Above 70 – 75 kg)
		Class ‘OPEN’ (Above 75 kg)
	Female Artistic	‘Single’

TO BE SUBMITTED LATEST BY 10th August 2013

 

 

	_________________________ Name / Designation

 

 

 

ENTRY BY NUMBER 14-17

 

COUNTRY / STATE: ­­­­­­____________________________________

 

No.	Function	Category / Function	Entry by Number
	Match Male	Class ‘A’ (Above 39 – 42 kg)
		Class ‘B’ (Above 42 – 45 kg)
		Class ‘C’ (Above 45 – 48 kg)
		Class ‘D’ (Above 48 – 51 kg)
		Class ‘E’ (Above 51 – 54 kg)
		Class ‘F’ (Above 54 – 57 kg)
		Class ‘G’ (Above 57 – 60 kg)
		Class ‘H’ (Above 60 – 63 kg)
		Class ‘I’ (Above 63 – 66 kg)
		Class ‘J’ (Above 66 – 69 kg)
		Class ‘K’ (Above 69 – 72 kg)
		Class ‘L’ (Above 72 – 75 kg)
		Class ‘OPEN’ (Above 75 kg)
	Male Artistic	‘Single’
	Female Match	Class ‘A’ (Above 39 – 42 kg)
		Class ‘B’ (Above 42 – 45 kg)
		Class ‘C’ (Above 45 – 48 kg)
		Class ‘D’ (Above 48 – 51 kg)
		Class ‘E’ (Above 51 – 54 kg)
		Class ‘F’ (Above 54 – 57 kg)
		Class ‘G’ (Above 57 – 60 kg)
		Class ‘H’ (Above 60 – 63 kg)
		Class ‘I’ (Above 63 – 66 kg)
		Class ‘OPEN’ (Above 66 kg)
	Female Artistic	‘Single’

TO BE SUBMITTED LATEST BY 10th August 2013

 

	____________________ Name / Designation		_____________________________ Signature / Federation Stamp		________________ Date

 

ENTRY BY NUMBER 12-14

 

COUNTRY / STATE: ­­­­­­____________________________________

 

No.	Function	Category / Function	Entry by Number
	Match Male	Class ‘A’ (Above 28 – 30 kg)
		Class ‘B’ (Above 30 – 32 kg)
		Class ‘C’ (Above 32 – 34 kg)
		Class ‘D’ (Above 34 – 36 kg)
		Class ‘E’ (Above 36 – 38 kg)
		Class ‘F’ (Above 38 – 40 kg)
		Class ‘G’ (Above 40 – 42 kg)
		Class ‘H’ (Above 42 – 44 kg)
		Class ‘I’ (Above 44 – 46 kg)
		Class ‘J’ (Above 46 – 48 kg)
		Class ‘K’ (Above 48 – 50 kg)
		Class ‘L’ (Above 50 – 52 kg)
		Class ‘OPEN’ (Above 52 kg)
	Male Artistic	‘Single’
	Female Match	Class ‘A’ (Above 28 – 30 kg)
		Class ‘B’ (Above 30 – 32 kg)
		Class ‘C’ (Above 32 – 34 kg)
		Class ‘D’ (Above 34 – 36 kg)
		Class ‘E’ (Above 36 – 38 kg)
		Class ‘F’ (Above 38 – 40 kg)
		Class ‘G’ (Above 40 – 42 kg)
		Class ‘H’ (Above 42 – 44 kg)
		Class ‘I’ (Above 44 – 46 kg)
		Class ‘OPEN’ (Above 46 kg)
	Female Artistic	‘Single’

TO BE SUBMITTED LATEST BY 10th August 2013

 

			__________________ Date

 

Contact Address

 

Officer’s Name
Contact Address and Telephone / mobile no.
Landline No.
Fax No.
E-Mail address

VISA SUPPORT:

If you need a visa support. Provide this is information to each participant

Personal information:

Surname: ………………….

F/name: ……………..

Date of birth: …………………

Place of bithr: …………………………

Passport no: ……………………………..

Date of Issue: ………………………………………….

Place of passport issue: ……………………………………..

Expiration date: ……………………………………..

Occupation: ………………………………………..

Place of work: ………………………………………………….

Marital status: …………………………………………………

Nationality: ………………………………………………..

Native language: ……………………………………….

Citizenship ………………………………………

Sex: ………………………………..

Home Address And @-mail: ……………………………………………..

Phone number: ………………………………………………

 

 

EXAMPLE:

Personal information:

Surname: Sukhorukova

F/name: Irina

Date of birth: 15.10.1990

Place of bithr: Tashkent city. Uzbekistan

Passport no: CK 2042777

Date of Issue: 15.11.2006

Place of passport issue: Tashkent

Expiration date: 14.10.2013

Occupation: Student

Place of work: The State Institute of Physical Culture. Tashkent city. Uzbekistan

Marital status: single

Nationality: Russian

Native language: Russ

Sitizenship: Uzbekistan

Sex: Female

Home Address And @-mail: House#11, Lisunova#6 Street, Tashkent city. Uzbekistan <[email protected]>

Phone number: (+99894)1772779