PLANILLA DE INSCRIPCION
FINALES NACIONAL RESISTENCIA –CHACO.2014
Gimnasio - Institución:………………………………………………
Profesor - Entrenador:…………………………………………….
Dirección: ……………… Localidad:
………. Cód.
Postal ………
Teléfono Particular: (.............)........................Celular:
……
Disciplina:…………………………………………….
Categoría:BABY,INFANTIL,JUVENIL”A”,JUVENIL”B”
,ADULTOS
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Nombre del Participante
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Edad
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Fecha de Nacimiento
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D.N.I
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Arancel de inscripción
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1
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2
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3
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4
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5
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6
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7
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8
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9
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10
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11
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12
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13
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14
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15
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16
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17
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18
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19
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20
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Exhibe
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Compite
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Valor Total de Inscripción: $.....
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