ENTRY FORM

2022 Para Dance Sport Mainhatten Cup

20.08./21.08.2022

Couple/Single	Partner / Man		Partner / Lady
Surname / Name
Date of birth dd/mm/year
Combi ST
Combi LA
DUO ST
DUO LA
Single Men
Single Women
Combi Freestyle
Duo Freestyle
Single Freestyle
Class 1-2 (please, indicate)
Wheelchair user (please, indicate who)
SDMS License number (2022 season):
STAFF coaches, supporters:
TRAVEL INFORMATION:
NPC:
Contact person:
Tel.		E-mail:

Amateur Declaration Statement:

An athlete is eligible to compete in World Para Dance Sport only if he or she is not a National coach in WPDS, team leader,

coach or representative of a national team, adjudicator, standing dancer from the Professional Division in Dance Sport.

“According to the clause 2.3 of the 2014-2017 IPC WPDS Rules and Regulations, I declare I am eligible to compete in World

Para Dance Sport”.

Athletes’ signature:

Date:

Entries should be sent by e-mail no later than 31. July 2022 to mainhattencup@web.de and Info@WorldParaDanceSport.org

Signature and stamp

National Paralympic Committee or relevant organization, endorsed by NPC