| Name of Federation:
__________________________________________________________ |
| Address:
___________________________________________________________________ |
| City:
________________________ State/Province: __________________ Postal
Code________ |
| Telephone (Day):
_____________________________ Fax:__________________________ |
| E-Mail:
_______________________________________________________________ |
| Federation President:
________________________________________________________ |
| Federation Secretary:
_______________________________________________________ |
| Official Submitting Form:
____________________________________Title: _______________ |
| Telephone:
_________________________________ Fax: ____________________________ |
| E-Mail:
__________________________________________________________ |
| Required - Tournament
Federation Code: ___________ |
|