TEAM A PR P ER E EG E IS I T S ER E ED D FO F R O M

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1 XXII FRENCH CUP ROUEN 2016 Preliminary Entry Form TEAM PREREGISTERED FORM Please return this Form before October 31th, 2015 at Rouen Olympic Club : ISU Member Team Name Category Country City Web-site Name of Team Manager Person to Contact Address Phone Fax Date Signature 1

2 XXII FRENCH CUP ROUEN 2016 JUDGES ENTRY FORM ISU Member: Judge: Substitute Judge: ARRIVAL: Date and time of arrival: Place of arrival: railway station Plane: Train: Bus: Car: Train: Bus: Car: Number DEPARTURE: Date and time of arrival: Place of arrival: Plane: Number HOTEL ROOM REQUEST Single room: Double room: Name of accompanying person: ISU Member Date, Signature Passport type photograph must be included with this form for accreditation. Please return before Saturday, December 05th

3 XXII FRENCH CUP ROUEN 2016 FORM 1 ISU Member TEAM ENTRY FORM Category Name of the team Number of Skaters Name of Team Leader Name of Team Manager Address Tel : Person to Contact Fax : Web-site: Address Tel : Name of the COACH Fax : Web-site: Name of the assistant COACH Date Signature Please return before Saturday, December 05 th

4 XXII FRENCH CUP ROUEN 2016 FORM 2 TEAM ENTRY FORM ISU MEMBER CATEGORY NAME OF TEAM TEAM LEADER CITY TEAM REPRESENTS NAME OF THE COACH NAME OF THE ASSISTANT COACH TEAM MANAGER MEDICAL PERSONNEL CHAPERON 1) CHAPERON 2) Competitors, in alphabetical order. Indicate the team captain with a C and male skaters with M NOM SURNAME DATE OF BIRTH CITIZENSHIP

5 XXII FRENCH CUP ROUEN 2016 FORM 3 PRESS INFORMATION FORM (Separate form for each team) This information will be used when presenting your team to the Press and Media SyS World Championships World Challenge Cup for Junior National Championships * International competitions * Year *Please indicate results for junior competitions with a J Place When was the Team formed? 5

6 XXII FRENCH CUP ROUEN 2016 FORM 4 COMPETITION MUSIC INFORMATION FORM (Separate form for each team) ISU Member : Category : Team Name : Coach : Assistant Coach: Short Program / Original Dance Year of first performance: Name of Music: 1 Composer: Duration of Music: Orchestra: Record Label / Number: Name of Music: 2 Composer: Duration of Music: Orchestra: Record Label / Number: Name of Music: 3 Composer: Duration of Music: Orchestra: Record Label / Number: Free Skating / Free Dance Year of first performance: Name of Music: 1 Composer: Duration of Music: Orchestra: Record Label / Number: Name of Music: 2 Composer: Duration of Music: Orchestra: Record Label / Number: Name of Music: 3 Composer: Duration of Music: Orchestra: Record Label / Number: Note: ISU Special Regulations Synchronized Skating, Rule 768, paragraph 7. The title of the music of the short program and free skating and the names of the composers must be submitted with the entries for the ISU Synchronized Skating Championships ISU Member Date, Signature 6

7 XXII FRENCH CUP ROUEN 2016 FORM 5 PROGRAM CONTENT SHEET ISU Member: Category : Name of Team: Name of a Person/Function given the Content Sheet: ELEMENTS IN ORDER OF SKATING DURING THE PROGRAM Time* Time* Elements Free Skating Elements Short Program * Time of element during the program. 7

8 XXII FRENCH CUP ROUEN 2016 MEDICAL FORM FORM 6 This form is valid for this Competition only. Please fill in with type or write in capital letters To improve medical care of each skater at ISU Events, in case of emergency, the ISU Medical Advisors request that the skaters fill out this form prior to the Event or at Registration/Accreditation of each event ISU Member : Category : Name of the Team : NAME : PASSPORT NUMBER: MEMBER: EMERGENCY CONTACT NAME AND NUMBER: ALLERGIES: YES / NO If yes, what type (food, medications (penicillin or others), pollen, dust etc): CURRENT MEDICAL CONDITIONS: Please list the conditions and any medications required. One form for each Skater 8

9 XXII FRENCH CUP ROUEN 2016 FORM 7 ENTRY FEES ISU Member Category Name of Team 400 Euros without any free ice practice 500 Euros including half (1/2) an hour of free ice practice 600 Euros including one (1) hour of free ice practice Please return this form with the payment Check in Euros or Bank Transfer: Rouen Olympic Club Centre Guy Boissière Patinoire ILE LACROIX ROUEN France Please note the detail of your payment: Name of Name team team of Name Bank of N cheque N Bank Transfer Entry fees Meals Total Please return before Wednesday, January 06th,

10 XXII FRENCH CUP ROUEN 2016 FORM 8 MEAL RESERVATION ISU Member : Category : Name of Team ADDRESS of HOTEL IN ROUEN Phone: Fax: PERSON TO CONTACT DAYS LUNCH WEDNESDAY February 03rd, 2016 Warm meal 11,00 x Choice of dairy Choice of dessert THURSDAY February 04th, 2016 Warm meal 11,00 x Choice of dairy Choice of dessert FRIDAY February 05th, 2016 Warm meal 11,00 x Choice of dairy Choice of dessert SATURDAY February 06th, 2016 Warm meal 11,00 x Choice of dairy Choice of dessert DINER TOTAL = 11,00 x = = 11,00 x = = 11,00 x = = 11,00 x = Total to pay in Euros First deposit: Method of payment : Cheque (in Euros) / Cash (in Euros) / Bank Transfer Please return before Tuesday, January 6th, 2016 at the later. If meals are canceled after January 15, 2016, they will not be refunded. 10

11 XXII FRENCH CUP ROUEN 2016 FORM 9 ARRIVAL TEAM ENTRY FORM ISU MEMBER : Name of Team : Category : PERSON TO CONTACT : PHONE : HOTEL in Rouen NAME : ADDRESS : PHONE : ARRIVAL : Arrival in France : DATE : TIME Arrival in Rouen DATE : TIME : Plane : Train : Bus : Car : Plane : Train : Bus : Car : DEPARTURE : DATE : TIME : 11

12 Liste d' Hotels et Hebergement Rouen et sa Région Rouen Tourisme Office B&B ROUEN PARC EXPO 35, avenue des Canadiens LE GRAND-QUEVILLY B&B ROND POINT DES VACHES Chemin des Grés Zone de l'etang SAINT-ETIENNE DU ROUVRAY CAMPANILE ROUEN SUD PARC EXPO - LOUVRE HOTEL Rue de la Mare aux Sansoure SAINT-ETIENNE DU ROUVRAY COMFORT HOTEL ROUEN ALBA HOTEL STARS 1, avenue des Canadiens

13 LE RELAIS DES 2 RIVIERES 33, boulevard Gambetta LE SISLEY 51, rue Jean Lecanuet PREMIERE CLASSE ROUEN NORD BOIS GUILLAUME - LOUVRE HOTELS Avenue de l'europe Technoparc des Bocquets BOIS-GUILLAUME PREMIERE CLASSE ROUEN SUD PARC EXPO - LOUVRE HOTELS 11, avenue des Canadiens SAINT-ETIENNE DU ROUVRAY ACCOR-IBIS ROUEN CENTRE RIVE DROITE** 56, quai Gaston Boulet ACCOR-IBIS ROUEN CENTRE RIVE GAUCHE ST SEVER** 44, rue Amiral Cécille ROUEN

14 ACCOR-IBIS ROUEN CHAMP DE MARS** 12, avenue Aristide Briand ACCOR-IBIS ROUEN SUD ZENITH** 29, avenue Maryse Bastié SAINT-ETIENNE DU ROUVRAY ALIVE HOTEL DE QUEBEC** 18-24, rue de Québec ARTS ET SEINE** 6, rue Saint-Etienne-des-Tonneliers ASTRID** 11, place Bernard Tissot BEAUSEJOUR** 9, rue Pouchet

15 CAMPANILE ROUEN SUD RD PT DES VACHES** - LOUVRE HOTELS 31, rue Désiré Granet SAINT-ETIENNE DU ROUVRAY CARDINAL** 1, place de la Cathédrale HOTEL D'ANGLETERRE**- CITOTEL 21, quai du Havre HOTEL DE L'EUROPE** 87-89, rue aux Ours HOTEL DE LA CATHEDRALE** 12, rue Saint-Romain HOTEL MORAND** 1 rue Morand

16 HOTEL DE PARIS** 12, rue la Champmeslé HOTEL DES CARMES** 33, place des Carmes HOTEL VERSAN** 3, rue Jean Lecanuet HOTEL VIEILLE TOUR** 42, place de la Haute Vieille Tour NTER HOTEL NOTRE DAME** 4, rue de la Savonnerie KYRIAD ROUEN CENTRE** - LOUVRE HOTELS 14, quai Gaston Boulet

17 LE VIEUX CARRE** 34, rue Ganterie ROUEN HOTEL SAINT-SEVER** 20, place de l'église Saint Sever ROUEN ACCOR-MERCURE CHAMP DE MARS*** 12, avenue Aristide Briand ACCOR-MERCURE ROUEN CENTRE CATHEDRALE*** 7, rue Croix de Fer ACCOR-NOVOTEL ROUEN SUD*** Rue de la Mare Sansoure - Le Madrillet SAINT-ETIENNE DU ROUVRAY ACCOR-SUITE NOVOTEL ROUEN NORMANDIE*** Ilôt Pasteur 10, quai de Boisguilbert

18 BEST WESTERN HOTEL DE DIEPPE*** Place Bernard Tissot BEST WESTERN HOTEL DU VIEUX MARCHE*** 15, rue de la Pie DANDY*** 93A, rue Cauchoise ERMITAGE BOUQUET*** 58, rue Bouquet QUALITY HOTEL LA BERTELIERE*** 1641, avenue du Mesnil Gremichon SAINT-MARTIN-DU-VIVIER HOTEL DE BOURGTHEROULDE***** 15, place de la Pucelle

19 MAP «ÎLE LACROIX» CENTRE GUY BOISSIERE, ROUEN Le Mini Club Maison de Q Patinoire Ice Rink Patinoire Ice Rink Bus Parking Patinoire Ice Rink 19

20 PATINOIRE DE L ILE LACROIX ROUEN 20

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