国家：截止日期： 9月 6日 2006.doc

国家: ___________________________________ 截止日期: 9月 6日 2006 运动员姓名:（中、英文）中文： Family name Given name 性别Gender 地址Address Home Town 体重 Weight (kg) 高度 Height (cm) 出生日 (dd/mm/yyyy) Occupation 籍贯 School/University I’ll send photo by Email 省（区市） 单位 联系电话 教练Personal Coach PERFORMANCES成绩 Events Name Personal Best Performances (time, place competition) We verify that this athlete is a member in good standings of affiliated Federation Date Name (print) Signature Federation Stamp Declaration: Release form Liability: I here by declare that I exonerate from all liability and responsibility however so arising, FINA, its affiliates, the Hosting National Federation Organising Committee and staff, and the venue owners, Sponsors, and any other persons that participate in the Championships, in respect to all and every action or claim about accidents that may occur (except liability and responsibility for personal injury or death caused due to the negligence of those respective bodies or persons). Doping Control Authorization: I agree to participate, if selected in random drug testing including blood testing at any time, either in or out of competition, as