Please fill out following questions if you need assistance or special request during 10th Hiroshima Peace Cup.

Entry will be accepted after you completed both "Online entry" and "PayPal payment".

Contact information

Name*
Gender*	M F
E-mail address*
Verify e-mail address*

Mobility aids

Mobility aids*	None Walker/Walking Frame Stick/Crutches etc. Wheelchair-Electric Wheelchair-Manual

Assistance during regatta

I have someone to assist me*	No, or no assistance required Yes
Assistance*	I/We require no assistance I/We require minimal assistance I/We require full assistance and/or C-Crane
Support boat*	No I will bring support boat
Special request if any
*Required fields