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Change of Details Form - IPC Athletics Official - Dear Classifier

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Change of Details Form - IPC Athletics Official - Dear Classifier Powered By Docstoc
					CHANGE IN DETAILS FORM

To assist IPC Athletics maintaining an accurate directory of personnel for international and regional assignments as well as
IPC Athletics communications please complete the enclosed form and return via email to ipcathletics@paralympic.org or fax
+49 228 2097 209.

PERSONAL INFORMATION

Name:

Address:

Email Address:

Phone:


FUNCTION / ROLE:


         Technical Official

         Classifier

         Administrator



ACTIVITY STATUS:
Indicating availability for assignments

         Active

         Not Active until [please insert date]

         Retired


CERTIFICATION - CLASSIFICATION:
Please mark as many boxes as applicable


         Chief Classifier

         Level 2

         Level 1

         Trainee




                                                                                              Page 1 of 3
CERTIFICATION – TECHNICAL OFFICIAL:
Please mark as many boxes as applicable


       Trainer

       ITO

       ATO

       Trainee


SPORT CLASS SPECIALISM - CLASSIFICATION:
Please mark as many boxes as applicable

       11-13

       32-38

       40-46

       51-58




TYPE OF CHANGE:


        Postal Address

        New Postal Address:



        Email Address

        New Email Address:



        Contact Phone

        New Contact Phone:


        Activity Status

        New Status:
       Other; please specify




TYPE OF COMMUNICATION

Please identify your preferred method of communication

       Email

       Phone

       Postal

       Other; please specify



Thank you in advance for taking the time to complete the form. It has assisted IPC Athletics greatly in maintaining an
accurate directory and a means to contact you in the future.

IPC Athletics look forward to working with you.

				
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posted:4/26/2010
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