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WWA
The
10th Anniversary Wakeboard World Series J-ROUND 2005
NISSAN X-TRAIL CUP in Odaiba Boukenou
Riders Registration
Form
First Name:______________________________________________
Last name:
______________________________________________
Address:_________________________________________________
City: State:
___________________________
Country:
____________________
Fax : Phone
: ______________________________
E-mail :____________________________________________
Date of
birth :_________________________________________
Board Sponsor
: ___________________________________________
Other Sponsor
:____________________________________________
________________________________________________________
________________________________________________________
(Date &
Signature)
________________________________________________________
For
Registration Form, send FAX or E-mail:
Fax
Number: 0081-(3)-3479-3011
E-mail Address: info@jwba.net
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