APPEAL TO THE JURY

Appeal Lodged on Behalf of: NPC: _______________________________

Athlete: ___________________________________ SDMS Number _____________________________

Bib Number: __________________ Class ____________ Event: ____________________________

Appeal Lodged by: ________________________________

Reason for the Appeal:

_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________
Action Requested:
_______________________________________________________________________________________
_______________________________________________________________________________________
_______________________________________________________________________________________

Signature: _________________________________

For TIC Use Only

Appeal submitted at: ______________ Date: __________________________________

Official Results Published at: _________ Referee Decided on Protest at: _________

Appeal Fee of 200€  received TIC Official: ____________________________

Decision of the Jury of Appeal

The appeal is upheld / rejected (Delete as applicable)

Further information is attached.

The Appeal Fee shall / shall not be returned.

Date and time: __________________________
Signatures:
_______________________________________________________________________________________

WPA 07