NAGPUR DISTRICT ATHLETI

DISTRICT SENIOR ATHLETICS CHA

ENTRYT FOR
Name of school/ College/ Club :-
Contact Person :- Nishikant Karmarkar Contact No. :- 9881820647
Age Group :- Above 16 Years Open Men/Women & Age Group Years 30 TO 40, 40 TO
MIDDLE MOTHER NAME
Sr. No. BIB NO I card no. SURNAME NAME NAME DOB AGE GROUP M/F

1 Karmarkar Nishikant Jagannath 4/24/1970 50-60 M

2
3
4
5
6
7
8
9
10
( TOTAL ENTRY FEES: ___________________________________________________________
Note:- 1) please fill up all coloumes.
2) Please mail your entry in exel file only.
3) Mobil number of the athlet will be must
4) please fill separate entry form for Boys & Girls Age Category.
5) NDAA I card number complesary to all athlete.
Name of the Principal:- Name of the Escort Teacher:-
Signature:- Signature:-
Mobile Number :- Watsapp Number :-
RICT ATHLETICS ASSOCIATION
OR ATHLETICS CHAMPIONSHIP' 2021
ENTRYT FORM
No. :- 9881820647
ars 30 TO 40, 40 TO 50 & 50 TO 60
Class Mobile No. Event 1 Event 2 Realay 1 Realay 2

9881820647 100m 200m

he Escort Teacher:-
Signature:-
Name of school/ College/ Club

/-