Nordic Deep Registration

Name:                                                        Nationality:

Aida member fee paid to which country:

Age:                                                           Occupation:

Suit (make and millimeter):

Amount of weights used:                            Fins (make):

Personalbests training during the last 12 months.

CWT:                       CNF:                         FIM:

STA:                         DNF:                         DYN:

Health certificate Đ date:            I have my own lanyard (yes/no):

Have you since the medical examination suffered from disease related to: heart, vascular system, lungs, ear or heavy infection?

Have you had scull injuries or heavy migrane since the last medical examination?

Have you during the last year had any; severe cramps, unexplained fainting, dizziness, epelepsi, or other unexplained disturbances in conciousness.

If yes, describe:

Are you taking any prescribed drugs. If yes, which one:

Are you pregnant:                     Do you fell strong and well?

Have you during the previous year taken eny substances that can be found on the IOC list of illegal substances? If yes, Which one?

I understand that that extreeme freediving can be dangerous and I will not dive above my ability in the competition.

Date:                         Signature: