LastName:

FirstName:

Sexe:
Male Female

e-mail:

country:

UniversityorHighSchool:

Dateofbirth:

Would you like to participate at the 4th World University Bridge Championship in Lodz (Poland) in 2008?

YES NO

If Yes, please give the name and email of the responsible of this club

Name:

e-mail:

Are you playing bridge in a university bridge club?

YES NO