Union Internationale de Pentathlon Moderne

2014 UIPM MODERN BIATHLE / TRIATHLE WORLD CHAMPIONSHIPSMen and Women

Pacific Naval Command, ESCUINTLA, GUATEMALA7th - 12th October 2014

Asociacion de Pentatlon Moderno de Guatemala

ENTRY FORM “A”Please complete using CAPITAL LETTERS and return before 8th August 2014

COUNTRY:NUMBER OF COMPETITORS:

CATEGORIEMODERN BIATHLE

MODERN BIATHLE

MODERN TRIATHLE

MODERN TRIATHLE B + T B + T MIXED RELAY

Per teamMALE FEMALE MALE FEMALE MALE FEMALE

Youth FYouth EYouth DYouth CYouth BYouth AJuniorsSeniorsMasters AMasters BMasters CMasters D

NUMBER OF COACHES/OFFICIALS: _________________ NUMBER OF OTHERS EXTRA: ___________________________________

FEDERATION: ___________________________________ CONTACT PERSON NAME: _________________________________________

EMAIL: _________________________________________ TEL: ________________________________________

NAME: _________________________________________ SIGNATURE: _________________________ DATE: ______________

For official use onlyPlease return to : GUATEMALAN MODERN PENTATHLON ASSOCIATION

3 Avenida, 16-15 ZONA 15, JARDINES DE MINERVA, GUATEMALA, TEL: +502- 2369-4489e-mail: penta.guate@gmail.com, website: www.pentatlonmodernoguatemala.com

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