Registration

WORLD COMPANY SPORT GAMES

REGISTRATION FORM

1rst of June 5th of June 2016, Palma de Majorca

PLEASE NOTE
- Arrival and departure dates of the competitors are fixed and cannot be changed (30rd of May the to
07th of June 2016)
- We will not be possible to make any reservations for non-employees or non-competitors
- To ensure eligibility, please return this form fully completed
The person selected, their line managers and their HR managers will receive information and practical
details about their participation at the event. The support they will receive include lodging, registration
fees, insurance, meals, equipment (this doesnt include footwear and technical materials),
transportation booked by us (this doesnt include parking and mileage costs). For the employees from
far-off countries, the airline tickets to Palma (the allocated 300 deducted from the airfare) will have
to be paid by the entity the selected employee comes from.
The participants must have settle their membership fees to Association Veolia Sport (AVS) (25). The
employees must ask for leave or recoveries to be part of our delegation.
In case of unjustified cancellation (illness ...), penalties may be claimed him.

A contribution of 25 for membership of AVS will be requested.

Veolia sportsathltetes who wish to still participate, even if they were not selected, can contact
the AVS organization staff.

I confirm that I have read the conditions mentioned above (costs supported and not supported
by Veolia, holydays to take, consequences of an unjustified cancellation ....). please cross the
case [x]

Please sign this document here:

ANDREI GIURCANAS

PERSONAL INFORMATION

LAST NAME: GIURCANAS

FIRST NAME: ANDREI

Sex (M or F): M
Date of birth (d/m/y): 16.05.1990
Nationality: ROMANIAN
NB : You will need a valid passport (or national ID card if relevant) to travel.

Registration form Palma 2016

Your job title: CIVIL ENGINEER

Your entity/business unit: VWST ROMANIA

Job address: Bd. Dimitrie Pompeiu 9A IRIDE BUSINESS PARK

Your e-mail address: andrei.giurcanas@veolia.com
Home address: Str. Badea Cartan nr. 64 Bl. 37A ap. 13
Airport nearby: Otopeni Henri Coanda OTP
Your office phone, including country code:

+40733972644

Phone number and e-mail address of a family member (just in case): +40752228852
Information about your Boss:
Last name:
Djeloyan
E-mail address: jm.djeloyan@acvatot.ro

First name: Jean-Michel

Information about your Supervisor:

Last name:
Predescu
E-mail address: ducu.predescu@veolia.com

First name: Ducu

SPORT * (please cross your sport)

Equipment:
Sweat size: L
Pants size: L
Shorts size: L
T-Shirt size: L
Shoes size: 45

Track&Field:

Long Distance Run:

Badminton:

Basketball:

Beach volleyball:

10-pin bowling

Cycling:

7-a-side football
>40 years old:

Golf:

Handball >
years old:

Swimming:

Petanque:

Squash:

Table tennis:

Volleyball:

Padel:

Para-Games:
Track&Field,

Para-Games:
Swimming

7-a-side rugby

7-a-side football:

Handball:
Tennis:
Para-Games:
Basketball

5-a-side football:

40
x

*All information about the different events is available on the website:

Registration form Palma 2016

INFORMATION ABOUT YOUR SPORT LEVEL:

Number of years of practice:

Tennis for about 10 years at professional level, regional champion in my youth.
Football 12 years. I play regularly 1 time a week 4+1 or 6+1.
Squash I recently discovered this sport and I play well considering its similar to tennis
Your highest competitions participation: Tennis ATP approved competition in 2005 in Bucharest
(quarter finals)
Position in the field (collectif sport) or specialty: for football - attack
Personal best results: multiple prizes in tennis competitions a long time ago
Federation name and License number: currently not registered
Others information: ..

Please return this registration form before December 20th 2015 to:

Email : avs@veolia.com
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