Kosice 2022 Para Dance Sport World CUP

8-14 September 2022

ENTRY FORM

Couple	Partner / Man		Partner / Lady
Surname / Name
Date of birth dd/mm/year
EVENTS
Combi ST
Combi LA
Combi Freestyle
Duo ST
Duo LA
Duo Freestyle
Single Conventional
Single Freestyle
Single Junior
Class 1-2 (please, indicate)
Wheelchair user (please, indicate who)
SDMS License 2022 season: (YES/NO)
NPC:
Address:
Contact person:
Telephone:		E-mail:

Amateur Declaration Statement according to the clause 3.3 of the 2018 WPDS Rules and Regulations:

“I confirm that I am not: a National Coach, Team Leader or Adjudicator. I also confirm that I am not a Professional

Standing Dancer and that if I once was I am now retired and have not competed as a Professional Standing Dancer

for at least one (1) consecutive year”

Athletes’ signature:

Date:

Signature and stamp:                            (                       )

National Paralympic Committee or relevant organization, endorsed by NPC.

The Entry Form should be sent by e-mail no later than 10 August 2022 to the LOC and WPDS.

E-mail: info@tkellegance.sk and Info@WorldParaDanceSport.org