Entry form Amstel Ice Swim
THE ENTRIES ARE CLOSED. We hope to see you next year!

Dear competitor,

Thank you for your interest in the third edition of the Amstel Ice Swim on December 28th and 29th, 2019. To complete the entry we would like to point out the safety rules and regulations of the International Ice Swimming Association and IISA Nederland. In order to complete the entry we need to following information.

With cool regards,
Organisation Amstel Ice Swim
(Sportmomentje)
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Name and surname *
I'm a: *
Date of birth *
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DD
/
YYYY
Emailaddress *
Rules and regulations
I've read the rules and regulations of the International Ice Swimming Association and understand that ice swimming is an extreme sport with risks.

https://www.internationaliceswimming.com/iisa-rules/
*
Required
I'm a member of IISA Nederland
Which distance(s) would you like to enter on Saturday 28th of December 2019? Pay attention, that there might be limited time inbetween programs.
Which distance(s) would you like to enter on Sunday 29th of December 2019? Pay attention, that there might be limited time inbetween programs.
Our relay team has the following members (TEAMNAAM and 4x name + surname):
My entry time on the 1000 m is (min:sec): *
Required
My entry time on the 200 m is (min:sec): *
Required
My entry time on the 500 m is (min:sec): *
Required
Have you participated during the trainings to prepare yourself for the Amstel Ice Swim? *
During the clinics and the competition it is mandatory to swim with a safety bouy. *
Street + nr *
Postal code + City + Country *
Mobile number: *
In case of emergency please contact (name + surname) *
Mobile number: *
Hereby, I agree that the organization of the Amstel Ice Swim is allowed to use the results and/or imagery for promotional purpose. *
Participant has entered the information above truthfully and agrees with his/her registration for the Amstel Ice Swim on Saturday 28th and/or Sunday 29th of December 2019. *
Required
* Invoice will be sent within one week by Sportmomentje
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