1 Dear sport friends, As every year, we organise - Kayak

1 Dear sport friends, As every year, we organise - Kayak

Dear sport friends,
As every year, we organise the International Tournament of Pas-de-Calais of Canoe Polo on April 26th
and 27th 2014.
This 15th edition will be organised in the city of Saint-Omer (north of France). You will find the entry
form and information about meals and accommodations (free camping).
Best regards,
José LENOIR
President of CDCK 62
Philippe LALLIOT
President of Saint-Omer club
1
This form is to be fulfil before 5th April 2014 !
Team name :
Division* ☐Under 16 ☐Dames
☐Division 1 (12 teams maxi)
☐Division 2 (18 teams maxi)
*Block the useless grades / If we have not 6 “dames” teams, these teams will play in Division 2
Team leader :
Address :
Post code :
City :
Country :
Email :
Phone :
Two choices of registration for Dames, Division 1 and Division 2*
☐Choice 1 : 70 € per team for registration only
☐Choice 2 : 250 € per team with registration, breakfasts (Saturday and Sunday), lunches (Saturday
and Sunday) and Saturday’s dinner.
*Block the useless choice
Two choices of registration for U16 teams
Choice 1 : 30 € per team for registration only
Choice 2 : 200 € per team with registration, breakfasts (Saturday and Sunday), lunches (Saturday and
Sunday) and Saturday’s dinner.
*Block the useless choice
Other choice
Only dinner for Saturday night at 12 € per person
12 € x _____ person = _____ euros
2
Winner of Division 1 = 150 €
Finalist of Division 1 = 100 €
3rd of Division 1 = 50 €
Winner of Division 2 = 100 €
Finalist of Division 2 = 70 €
3rd of Division 2 = 40 €
Winner of Women Division = 100 €
Finalist of Women division = 70 €
3rd of Women Division = 40 €
Club name :
Number
SURNAME
SURNAME
Camping : ☐YES
NAME
NAME
Birth date
License Number
QUALIFICATIONS
☐NO
3
Registrations will be definitely taken into account on receiving of the regulation.
Bank : CL Saint-Omer (06034)
Name of account holder : CDCK 62
IBAN : FR63 3000 2060 3400 0011 7029 A71
BIC : CRLYFRPP
Email : [email protected]
4