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EUROPEAN AMATEUR CHAMPIONSHIP 2009 CHANTILLY GOLF CLUB 19th - 22nd of August 2009

MEDICAL CERTIFICATE FORM (please fill in with capital letters)

According to our French laws and rules, a Medical Certificate is required for all players entering any Championship in France.

Each player has to return it, before the beginning of the championship, to be able to play the 2009 IEAC.

Please return this form duly completed by fax: FFGOLF – 68 rue Anatole France – 92309 LEVALLOIS PERRET CEDEX – FRANCE Tel. +33 (0) 1 41 49 77 40 – Fax +33 (0) 1 41 49 77 22 – Email : sportif@ffgolf.org

I, the undersigned, examination of :

Doctor of Medicine, certify that the

MEDICAL CERTIFICATE OF NO CONTRAINDICATION TO THE PRACTICE OF GOLF

Mr : …….………………………………….………….…

  • ……

    .……………………………………………………………..…

  • ……………………………

    ..……. years’ old

Reveals no contraindications for practicing golf in competitions.

Issued on the : ………..……………..….……………..…….…

PLAYER’S NATION:

Signature of Doctor :

Stamp of doctor’s office

____________________________

  • …………………

    ..…………..…

European Individual Championship

Advice : we recommend you to keep a copy of your medical certificate with you.

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