INSCRIPTION FORM SIA BENIGANIM
PLAYER
Name
Surname
DNI / PASSPORT
DATE OF BIRTH
E-MAIL ADDRESS
NATIONALITY
France
Belgium
Luxembourg
Switzerland
_________________
Afghanistan
Albania
Algeria
American Samoa -
Andorra
Angola
Anguilla -
Antarctica
Antigua and Barbuda -
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas -
Bahrain
Bangladesh
Barbados -
Belarus
Belize
Benin
Bermuda -
Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
British Indian Ocean Territory
British Virgin Islands -
Brunei
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands -
Central African Republic
Chad
Chile
China
Christmas Island
Cocos Islands
Colombia
Comoros
Cook Islands
Costa Rica
Croatia
Cuba
Curacao
Cyprus
Czech Republic
Democratic Republic of the Congo
Denmark
Djibouti
Dominica-
Dominican Republic-
East Timor
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
French Polynesia
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada-
Guam-
Guatemala
Guernsey-
Guinea
Guinea-Bissau
Guyana
Haiti
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man-
Israel
Italy
Ivory Coast
Jamaica-
Japan
Jersey-
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Macau
Macedonia
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat-
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
North Korea
Northern Mariana Islands-
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico-
Qatar
Republic of the Congo
Reunion
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis-
Saint Lucia-
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines-
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten-
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Swaziland
Sweden
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Togo
Tokelau
Tonga
Trinidad and Tobago-
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands-
Tuvalu
U.S. Virgin Islands-
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican
Venezuela
Vietnam
Wallis and Futuna
Western Sahara
Yemen
Zimbabwe
PREFIX
France(+33)
Belgium (+32)
Luxembourg(+352)
Switzerland(+41)
_________________
Afghanistan(+93)
Albania (+355)
Algeria (+213)
American Samoa (+1-684)
Andorra (+376)
Angola (+244)
Anguilla (+1-264)
Antarctica (+672)
Antigua and Barbuda (+1-268)
Argentina (+54)
Armenia (+374)
Aruba (+297)
Australia (+61)
Austria (+43)
Azerbaijan (+994)
Bahamas (+1-242)
Bahrain (+973)
Bangladesh (+880)
Barbados (+1-246)
Belarus (+375)
Belize (+501)
Benin (+229)
Bermuda (+1-441)
Bhutan (+975)
Bolivia (+591)
Bosnia and Herzegovina (+387)
Botswana (+267)
Brazil (+55)
British Indian Ocean Territory (+246)
British Virgin Islands (+1-284)
Brunei (+673)
Bulgaria (+359)
Burkina Faso (+226)
Burundi (+257)
Cambodia (+855)
Cameroon (+237)
Canada (+1)
Cape Verde (+238)
Cayman Islands (+1-345)
Central African Republic (+236)
Chad (+235)
Chile (+56)
China (+86)
Christmas Island(+61)
Cocos Islands(+61)
Colombia(+57)
Comoros(+269)
Cook Islands(+68)
Costa Rica(+506)
Croatia(+385)
Cuba(+53)
Curacao(+599)
Cyprus(+357)
Czech Republic(+420)
Democratic Republic of the Congo(+243)
Denmark(+45)
Djibouti(+253)
Dominica(+1-767)
Dominican Republic(+1-809)
East Timor(+670)
Ecuador(+593)
Egypt(+20)
El Salvador(+503)
Equatorial Guinea(+240)
Eritrea(+291)
Estonia(+372)
Ethiopia(+251)
Falkland Islands(+500)
Faroe Islands(+298)
Fiji(+679)
Finland(+358)
French Polynesia(+689)
Gabon(+241)
Gambia(+220)
Georgia(+995)
Germany(+49)
Ghana(+233)
Gibraltar(+350)
Greece(+30)
Greenland(+299)
Grenada(+1-473)
Guam(+1-671)
Guatemala(+502)
Guernsey(+44-1481)
Guinea(+224)
Guinea-Bissau(+245)
Guyana(+592)
Haiti(+509)
Honduras(+504)
Hong Kong(+852)
Hungary(+36)
Iceland(+354)
India(+91)
Indonesia(+62)
Iran(+98)
Iraq(+964)
Ireland(+353)
Isle of Man(+44-1624)
Israel(+972)
Italy(+39)
Ivory Coast(+225)
Jamaica(+1-876)
Japan(+81)
Jersey(+44-1534)
Jordan(+962)
Kazakhstan(+7)
Kenya(+254)
Kiribati(+686)
Kosovo(+383)
Kuwait(+965)
Kyrgyzstan(+996)
Laos(+856)
Latvia(+371)
Lebanon(+961)
Lesotho(+266)
Liberia(+231)
Libya(+218)
Liechtenstein(+423)
Lithuania(+370)
Macau(+853)
Macedonia(+389)
Madagascar(+261)
Malawi(+265)
Malaysia(+60)
Maldives(+960)
Mali(+223)
Malta(+356)
Marshall Islands(+692)
Mauritania(+222)
Mauritius(+230)
Mayotte(+262)
Mexico(+52)
Micronesia(+691)
Moldova(+373)
Monaco(+377)
Mongolia(+976)
Montenegro(+382)
Montserrat(+1-664)
Morocco(+212)
Mozambique(+258)
Myanmar(+95)
Namibia(+264)
Nauru(+674)
Nepal(+977)
Netherlands(+31)
Netherlands Antilles(+599)
New Caledonia(+687)
New Zealand(+64)
Nicaragua(+505)
Niger(+227)
Nigeria(+234)
Niue(+683)
North Korea(+850)
Northern Mariana Islands(+1-670)
Norway(+47)
Oman(+968)
Pakistan(+92)
Palau(+680)
Palestine(+970)
Panama(+507)
Papua New Guinea(+675)
Paraguay(+595)
Peru(+51)
Philippines(+63)
Pitcairn(+64)
Poland(+48)
Portugal(+351)
Puerto Rico(+1-787)
Qatar(+974)
Republic of the Congo(+242)
Reunion(+262)
Romania(+40)
Russia(+7)
Rwanda(+250)
Saint Barthelemy(+590)
Saint Helena(+290)
Saint Kitts and Nevis(+1-869)
Saint Lucia(+1-758)
Saint Martin(+590)
Saint Pierre and Miquelon(+508)
Saint Vincent and the Grenadines(+1-784)
Samoa(+685)
San Marino(+378)
Sao Tome and Principe(+239)
Saudi Arabia(+966)
Senegal(+221)
Serbia(+381)
Seychelles(+248)
Sierra Leone(+232)
Singapore(+65)
Sint Maarten(+1-721)
Slovakia(+421)
Slovenia(+386)
Solomon Islands(+677)
Somalia(+252)
South Africa(+27)
South Korea(+82)
South Sudan(+211)
Spain(+34)
Sri Lanka(+94)
Sudan(+249)
Suriname(+597)
Svalbard and Jan Mayen(+47)
Swaziland(+268)
Sweden(+46)
Syria(+963)
Taiwan(+886)
Tajikistan(+992)
Tanzania(+255)
Thailand(+66)
Togo(+228)
Tokelau(+690)
Tonga(+676)
Trinidad and Tobago(+1-868)
Tunisia(+216)
Turkey(+90)
Turkmenistan(+993)
Turks and Caicos Islands(+1-649)
Tuvalu(+688)
U.S. Virgin Islands(+1-340)
Uganda(+256)
Ukraine(+380)
United Arab Emirates(+971)
United Kingdom(+44)
United States(+1)
Uruguay(+598)
Uzbekistan(+998)
Vanuatu(+678)
Vatican(+379)
Venezuela(+58)
Vietnam(+84)
Wallis and Futuna(+681)
Western Sahara(+212)
Yemen(+967)
Zimbabwe(+263)
TELEPHONE
POSITION OF THE PLAYER
GOALKEEPER
DEFENDER
MIDFIELDER
STRIKER
HEALTH CARD NUMBER
CURRENT CLUB
DATES
From the 3 until 8 August
From the 10 until 15 August
From the 17 until 22 August
From the 24 until 29 August
From the 31 August until 5 September
PRICE
795 € From Monday to Saturday at midday
ADDITIONAL OPTIONS (Not included in the price)
Extra night prior to trial - 60€
Extra night - 60€
One-way transfer (Valencia Airport - Soccer Inter-Action) - 100 €
Return transfer (Soccer Inter-Action - Valence Airport) - 100 €
One-way transfer (Alicante Airport - Soccer Inter-Action) - 180 €
Return transfer (Soccer Inter-Action - Alicante Airport) - 180 €
MEDICAL INFORMATION OF INTEREST
Important information
PAYMENT
IBAN: ES76-0049-4900-05-2616075304
BIC / SWIFT: BSCHESMMXXX
In the Concept field, indicate the name and surname of the participant.
*send the proof of payment/transfer to the following email address:
davidcastello@soccerinteraction.com
AUTHORIZATION
I authorize the participant to attend the activities of the Trial of UD SIA Beniganim. I extend this authorization to the surgical decisions necessary to be taken, in case of extreme urgency, under the supervision of the medical team, expressly waiving any responsibility to Soccer Inter-Action SL or to their coaches/monitors, for injuries that may originate in the practices carried out on the Camp, which I assume in its entirety.
I accept the terms and conditions of the authorization
DATA PROTECTION
In compliance with the provisions of Law 15/1999 of 13 December on the Protection of Personal Data, we inform you that by filling out this form gives us your consent for your personal data and the participant are incorporated and processed in a file of personal data, property of Soccer Inter-Action SL guaranteeing its security and confidentiality, in order to provide and market our services, which is why it is necessary to fill in all fields of this form, understanding that the data provided must be true and up to date, so please notify us of any changes. Likewise, you agree to the publication of the captured images in which the participant may appear during the activities of the Trial of UD SIA Beniganim, in any support of the company, for legitimate activities. Please note that you may exercise your rights of access, rectification, cancellation and opposition at any time if you inform us.
I accept the terms and conditions of the authorization
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