Ficha Insc Jpa (1)
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Ficha de Inscrição Curso de Juízes de Pólo-Aquático (26 e 27 Setembro 2009) Nome ___________________________________________________________ Data de Nascimento ____ /_____/_______ Nº Contribuinte ___________________ B. I. ______________________ Morada _________________________________________________________ Localidade _____________________ C Postal ______-_____ _____________ Telefone _____________ Telemóvel _______________ E-Mail ________________________@ _____________ Habilitações Literárias ________________________________________ Profissão ____________________________________________________ Perspectivas após o Curso _____________________________________ ____________________________________________________________ ____________________________________________________________ Taxa de inscrição: 15,00 € Pago em: numerário_______________ Cheque _______________ Vale CTT ___________
Ass. do Candidato ____________________________________________
Ass. do Candidato ____________________________________________
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