Form B

TO BE RETURNED TO:

E.C.C. Rome 2011, oc@eccroma2011.it
UNTIL:

BEFORE 1st MARCH 2011
Team Name:
Capitan or Representative:
E-mail address:
Person Attending:
Amount 3rd payment (€)
Arrival date/time
Flight number arrival
Airport of arrival
Departure date/time
Flight number departure
Airport of departure
Please post the list of participants
Participant 1
P1 Name:
P1 Surname:
P1 Date of Birth:
P1 Nationality:
Participant 2
P2 Name:
P2 Surname:
P2 Date of Birth:
P2 Nationality:
Participant 3
P3 Name:
P3 Surname:
P3 Date of Birth:
P3 Nationality:
Participant 4
P4 Name:
P4 Surname:
P4 Date of Birth:
P4 Nationality:
Participant 5
P5 Name:
P5 Surname:
P5 Date of Birth:
P5 Nationality:
Participant 6
P6 Name:
P6 Surname:
P6 Date of Birth:
P6 Nationality:
Participant 7
P7 Name:
P7 Surname:
P7 Date of Birth:
P7 Nationality:
Participant 8
P8 Name:
P8 Surname:
P8 Date of Birth:
P8 Nationality:
Participant 9
P9 Name:
P9 Surname:
P9 Date of Birth:
P9 Nationality:
Participant 10
P10 Name:
P10 Surname:
P10 Date of Birth:
P10 Nationality:
Participant 11
P11 Name:
P11 Surname:
P11 Date of Birth:
P11 Nationality:
Participant 12
P12 Name:
P12 Surname:
P12 Date of Birth:
P12 Nationality:
Participant 13
P13 Name:
P13 Surname:
P13 Date of Birth:
P13 Nationality:
Participant 14
P14 Name:
P14 Surname:
P14 Date of Birth:
P14 Nationality:
Participant 15
P15 Name:
P15 Surname:
P15 Date of Birth:
P15 Nationality:
Participant 16
P16 Name:
P16 Surname:
P16 Date of Birth:
P16 Nationality:
Participant 17
P17 Name:
P17 Surname:
P17 Date of Birth:
P17 Nationality:
Participant 18
P18 Name:
P18 Surname:
P18 Date of Birth:
P18 Nationality:
Participant 19
P19 Name:
P19 Surname:
P19 Date of Birth:
P19 Nationality:
Participant 20
P20 Name:
P20 Surname:
P20 Date of Birth:
P20 Nationality:
Participant 21
P21 Name:
P21 Surname:
P21 Date of Birth:
P21 Nationality:
Participant 22
P22 Name:
P22 Surname:
P22 Date of Birth:
P22 Nationality:
Participant 23
P23 Name:
P23 Surname:
P23 Date of Birth:
P23 Nationality:
Participant 24
P24 Name:
P24 Surname:
P24 Date of Birth:
P24 Nationality:
Participant 25
P25 Name:
P25 Surname:
P25 Date of Birth:
P25 Nationality:
Participant 26
P26 Name:
P26 Surname:
P26 Date of Birth:
P26 Nationality:
Participant 27
P27 Name:
P27 Surname:
P27 Date of Birth:
P27 Nationality:
Participant 28
P28 Name:
P28 Surname:
P28 Date of Birth:
P28 Nationality:
Participant 29
P29 Name:
P29 Surname:
P29 Date of Birth:
P29 Nationality:
Participant 30
P30 Name:
P30 Surname:
P30 Date of Birth:
P30 Nationality:
Participant 31
P31 Name:
P31 Surname:
P31 Date of Birth:
P31 Nationality:
Participant 32
P32 Name:
P32 Surname:
P32 Date of Birth:
P32 Nationality:
Participant 33
P33 Name:
P33 Surname:
P33 Date of Birth:
P33 Nationality:
Participant 34
P34 Name:
P34 Surname:
P34 Date of Birth:
P34 Nationality:
Participant 35
P35 Name:
P35 Surname:
P35 Date of Birth:
P35 Nationality:
Participant 36
P36 Name:
P36 Surname:
P36 Date of Birth:
P36 Nationality:
Participant 37
P37 Name:
P37 Surname:
P37 Date of Birth:
P37 Nationality:
Participant 38
P38 Name:
P38 Surname:
P38 Date of Birth:
P38 Nationality:
Participant 39
P39 Name:
P39 Surname:
P39 Date of Birth:
P39 Nationality:
Participant 40
P40 Name:
P40 Surname:
P40 Date of Birth:
P40 Nationality:
Participant 41
P41 Name:
P41 Surname:
P41 Date of Birth:
P41 Nationality:
Participant 42
P42 Name:
P42 Surname:
P42 Date of Birth:
P42 Nationality:
Participant 43
P43 Name:
P43 Surname:
P43 Date of Birth:
P43 Nationality:
Participant 44
P44 Name:
P44 Surname:
P44 Date of Birth:
P44 Nationality:
ECC ROME 2011 BANK ACCOUNT
Purpose/Holder

ASD ECC ROMA 2011
Account Member

1079
Bank name, Address

CREDITO ARTIGIANO
IBAN

IT57N0351203202000000001079
BIC SWIFT

ARTIITM2
Privacy

I agree to the document Privacy E.C.C. ROME 2011 for processing data written in this form
I agree
Date

23-02-2012

E.C.C. ROME 2011

Form B

Payments