IPA Registration application form — Irish Petanque Association

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Registration form

Map of where to play

training manuals

Policy Documents

Registration form

Map of where to play

training manuals

Policy Documents

Folder: Information

Registration form

Map of where to play

training manuals

Policy Documents

Irish Petanque Association

Registration Form

petanque boule

Name *

First Name

Last Name

Nominated Club

Address

Address 1

Address 2

City

State/Province

Zip/Postal Code

Country

Date of birth

MM

DD

YYYY

Gender

Phone

(###)

###

####

Email *

Section B - Citizenship

Do you hold an Irish passport or are eligible to apply for one?

yes

no

Section C – Residency

To be completed by players who do not hold an Irish passport, and are not eligible to apply for one. Are you resident in Ireland, and intend to remain so for the next 12 consecutive months?

yes

no

Date of arrival in Ireland

Section D - CEP Membership

Do you hold an International Petanque Licence with another federation?

yes

no

Licence

Have you held an International Petanque Licence with another federation within the last 5 years?

yes

no

Section E – PUBLICATION OF INFORMATION

The IPA publishes details of photographs, names and other information about members on their website and social media. Do you consent for your photograph, name, and other information that is related to Petanque to be published in this way?

yes

no

Section F – DECLARATION *

I declare that to the best of my knowledge, all information I have provided in this application form is true and correct. I understand that in the event it is found the information I have provided is inaccurate, that I am responsible and as such subject to any sanction that may be imposed on me.

Date

MM

DD

YYYY

Thank you!

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