Prague 2023 Para Dance Sport

international Competition

7-8 October 2023

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)
SDMS License
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 organisation, endorsed by NPC.

The Entry Form should be sent by e-mail no later than 4 September 2023 to the LOC and WPDS.

E-mail: info@pragueparadance.cz and Info@WorldParaDanceSport.org