APPLICATION FORM - INTERNATIONAL ATHLETES LICENCE - 2012

FEDERATION       Climbing Federation of Russia                           COUNTRY  RUS

ADDRESS 119991, 242а- 8, Luzhnetskaya nab., Moscow

COMPETITOR

Surname:	Ivanov	Given Name:	Ivan
Sex:	Male /female	Date of Birth (d/m/y): 1998-03-01	
Address:	Volgina, 12-2-29 
City:	Moscow	Country: 	RUS	Postcode: 117485  
Cell / Mobile Tel.: +79035554882	Other Tel.	+79035554882
(with international code)
 E-mail:	ivanov@mail.ru