ENTRY FORM

1.	Full name:	_______________________	_______________________	_______________________
		LAST (surname, family)	FIRST	SECOND
2.	Date of birth:	_______________________
		Day, Month, Year
	Place_of_birth:	_______________________
3.	Applicant's native country if different from country of birth			_______________________
4.	Name, date and place of birth of applicant's spouse and children (if any)
	_________________________________________		_______________________	_______________________
	NAME		Date of birth (day, month, year)	Place of birth
	_________________________________________		_______________________	_______________________
	NAME		Date of birth (day, month, year)	Place of birth
	_________________________________________		_______________________	_______________________
	NAME		Date of birth (day, month, year)	Place of birth
5.	Full mailing address:		_________________________________________
			_________________________________________
			_________________________________________
			_________________________________________
			_________________________________________
6.	Photograph: Attach a recent, preferably less than 6 months old, photograph of the applicant, 1.5 inches (37 mm) square in size, with the applicants name printed on the back. The photograph, not a photocopy should be attached to the entry form with clear tape - do not use staples or paperclips, which can jam the mail processing equipment.)
7.	Signature:	________________________________________________________
		Failure to personally sign the entry form will disqualify the applicant

My complete E-Mail address is:	____________________________
Bank Transfer, Cheque/Money(postal) Order No:	____________________________
Date:	____________________________

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Important: When printing the entry form, please make sure that your signature is on page 1.

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