Ibsa Futsal Development

IBSA FUTSAL DEVELOPMENT

PROJECT EUROPE

BLIND FUTSAL SEMINARS FOR B2/B3 COACHES,

Sanremo, Italy,

11th – 13th May 2012

In partnership with:

REGISTRATION FORM

Please complete and return this registration form (one per participant) by Saturday 31st March to:

David Stirton

Project Co-ordinator

c/o ONCE

Almansa 66

28039 Madrid

Spain

Tel: + 34 91 436 53 49

Mobile: + 34 67o 087 637

E-mail:

Web: www.ibsa.es

You may return the form by E-mail or post. Please indicate your preferred method of transport; we shall contact you regarding your travel arrangements upon receiving the form.

For any questions regarding local matters in Italy, please contact:

Giancarlo di Malta -

Country:

Name of organisation:

First name of participant:

Surname of participant:

Nationality:

Date of birth:

Gender:

Male Female

Participant’s address:

Telephone:

Fax:

E-mail:

Please indicate his or her coaching qualifications and experience in B2/B3 Futsal:

Preferred travel itinerary:

Languages spoken:

Special dietary needs:

Additional comments: