PRIHLÁŠKA / ENTRY FORM

BEH BUČINY 2019

14. September 2019

Meno First name
Priezvisko Surname
Klub / Firma Club / Company name
Mesto City
PSČ Zip-code
Štát Country	Česká RepublikaSlovenská RepublikaAfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongoCongo, The Democratic Republic of TheCook IslandsCosta RicaCote D'ivoireCroatiaCubaCyprusDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland Islands (Malvinas)Faroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuineaGuinea-bissauGuyanaHaitiHeard Island and Mcdonald IslandsHoly See (Vatican City State)HondurasHong KongHungaryIcelandIndiaIndonesiaIran, Islamic Republic ofIraqIrelandIsraelItalyJamaicaJapanJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyan Arab JamahiriyaLiechtensteinLithuaniaLuxembourgMacaoMacedonia, The Former Yugoslav Republic ofMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesia, Federated States ofMoldova, Republic ofMonacoMongoliaMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorwayOmanPakistanPalauPalestinian Territory, OccupiedPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussian FederationRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and The GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbia and MontenegroSeychellesSierra LeoneSingaporeSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and The South Sandwich IslandsSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyrian Arab RepublicTaiwan, Province of ChinaTajikistanTanzania, United Republic ofThailandTimor-lesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States Minor Outlying IslandsUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweCanary Islands
Dátum narodenia Date of Birth
Meno zakonného zástupcu Legal guardian first name
Priezvisko zakonného zástupcu Legal guardian last name
Telefónne číslo zakonného zástupcu Legal guardian phone
E-mail zakonného zástupcu Legal guardian e-mail
Pohlavie Gender	muž / manžena / woman
Telefónne číslo Telephone number
E-mail
Disciplína Discipline	A. MUŽI – Hlavná kategória (od 18 do 40 rokov)B. MUŽI – (od 40 do 50 rokov)C. MUŽI – (od 50 rokov)D. ŽENY – (od 18 rokov)E. DORAST chlapci (do 18 rokov)F. DORAST dievčatá (do 18 rokov)

Prehlasenie:	Declaration:
Prehlasujem, že som dostatočne pripravený pre účasť na zvolenej disciplíne, som zdravý, absolvoval som potrebnú lekársku prehliadku a štartujem na vlastnú zodpovednosť.	I hereby attest and certify that I am physically fit and sufficiently trained for the participation in chosen discipline, my physical condition has been verified by a licenced medical doctor and I compete under my own responsibility.
Odoslaním formulára prehlasujem, že mi boli poskytnuté relevantné „informácie o spracúvaní osobných údajov.“	By sending this document I declare that I am aware of terms of “Personal data processing.“

Odoslaním tohto formulára súhlasím s uvedenými podmienkami

By submitting this form you agree with stated terms and conditions

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