This form can be downloaded from www.fiba.com (Experts/Medical Corner)
and can be completed electronically.
Player’s photo
Please stick here
(do not staple)
PLAYER'S CONSENT FORM
(Player’s personal data form for doping control)
PLAYING FOR THE NATIONAL TEAM/CLUB: ___________________________________________________________________
I, the undersigned, hereby give my consent to the national federation of ________________________________________________
to provide FIBA with my personal contact details and those of my club as follows:
Player’s family name (s)
First
Name(s)
Nationality:
Date of Birth
Home address
(Street, City, Country)
Home Tel. number
Mobile Tel. number
Club’s name & address of the
Club’s training facility (Street,
City, Country)
Tel. number
I hereby confirm that I am aware of the regulations and penalties in force relating to the fight against doping. I agree to submit to
the doping control tests (including out of competition tests by FIBA, WADA or any organization commissioned by FIBA or WADA),
to accept the results of such tests and to abide by the respective regulations as applicable from time to time. I have read and
understood the attached player’s information notice regarding doping-control related data and hereby consent to the processing of
my personal data in accordance with the applicable anti-doping Regulations. This information will be used by FIBA, WADA or other
competent Anti-Doping Organisations.
I agree that any dispute arising between myself and FIBA which cannot be settled amicably and which remains unsettled once the
procedures provided for in the FIBA Regulations have been exhausted, shall be settled finally by a tribunal composed in
accordance with the Statute and Regulations of the Court of Arbitration for Sport, Lausanne, Switzerland, to the exclusion of any
recourse to ordinary courts. The parties undertake to comply with the said Statutes and Regulations and to accept in good faith the
award rendered and in no way hinder its execution.
Player’s signature
099_11e
Date (day/month/year)
Signature & stamp of national federation