Inscription du Bénévole • Volunteer Registration
Informations générales • Contact Information
Prénom•First Name
Nom•Last Name
Adresse1•Address1
Adresse2•Address2
Ville•City
État•Province/State
Pays•Country	Abkhazia Afghanistan Aland Albania Algeria American Samoa Andorra Angola Anguilla Antigua and Barbuda Argentina Argentina Armenia Aruba United Kingdom Ascension Island Australia Austria Azerbaijan The Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Brazil Brunei Bulgaria Burkina Faso Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile People's Republic of China Republic of China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Polynesia Gabon The Gambia Georgia Germany Ghana Gibraltar Greece Greenland Grenada Guam Guatemala Guernsey Guinea Guinea-Bissau Guyana Guyana Haiti Haiti Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jersey Jordan Kazakhstan Kenya Kiribati North Korea South Korea Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Mauritania Mauritius Mayotte Mexico Micronesia Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Nagorno-Karabakh Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Turkish Republic of Northern Cyprus Northern Mariana Norway Pakistan Palau Palestine Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Islands Poland Portugal Transnistria Pridnestrovie Puerto Rico Qatar Romania Russia Rwanda Saint Barthelemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin Saint Pierre and Miquelon Saint Vincent and the Grenadines Samoa San Marino Saudi Arabia Senegal Serbia Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia Somaliland South Africa South Ossetia Spain Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Tajikistan Tanzania Thailand Timor-Leste Togo Tokelau Tonga Trinidad and Tobago Tristan da Cunha Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Vatican City Venezuela Vietnam British Virgin Islands US Virgin Islands Wallis and Futuna Western Sahara Yemen Zambia Zimbabwe
Code Postal • Postal Code
Courriel•E-mail *
Téléphone résidence•Home Phone *
Téléphone travail•Work Phone
Cellulaire•Mobile Phone
Langues Parlées•Languages Spoken	Anglais•English Français•French
Quelle est l'Association de Voile Adaptée avec laquelle vous êtes associé? • Which Disabled Sailing Association are you affiliated with?
J'ai de l'expérience avec: • I have experience with:	gréer/dégréer le voilier • boat rigging/derigging transferts • transfers accompagnateur • companion
Autre • Other
Compléter toutes les sections avant de cliquer le bouton "submit" • Complete all sections before you click Submit
RAPPEL: Une étoile rouge qui suffit que vous DEVEZ compléter le champ avec des informations valides • REMEMBER: A red star means you MUST complete the field with valid information.
Vous devriez recevoir un courriel confirmant la réception de votre demande d'inscription d'ici un à deux jours. N'hésitez pas à contacter les organisateurs de la coupe mobilité pour vous assurer que vos informations ont été reçues. • You should receive an email acknowledging receipt of your application within one or two days. Don't hesitate to contact Mobility Cup organizers to confirm your information has arrived.