MIME-Version: 1.0 Content-Type: multipart/related; boundary="----=_NextPart_01C6B7AA.5E2145C0" Questo documento è una pagina Web in file unico, nota anche come archivio Web. La visualizzazione di questo messaggio indica che il browser o l'editor in uso non supporta gli archivi Web. Scaricare un browser che supporti gli archivi Web, come Microsoft Internet Explorer. ------=_NextPart_01C6B7AA.5E2145C0 Content-Location: file:///C:/17C5C605/AGOSTOPETILINOMODELLOISCRIZIONE.htm Content-Transfer-Encoding: quoted-printable Content-Type: text/html; charset="us-ascii" AGOSTO PETILINO MODELLO ISCRIZIONE

<= /span>Petilia Policastro

AGOSTO PET= ILINO 2006

MODELLO ISCRIZIONE

Una Corsa nel Parco Nazionale= della Sila

Villaggio Principe, 13 Agosto 2006

=

IL/LA SOTTOSCRITTO/A ………………………̷= 0;…………………………= 230;……………….

NATO/A a …………………………̷= 0;…………………………= 230;…. IL …………………………

RESIDENTE A ………………………….R= 30;……………… IN VIA ……….. = 230;………………..

………………………̷= 0; TEL. ……………………… .

Chiede di partecipare alla corsa campestre, come da programma, raggiungendo autonomamente il Villaggio Principe; l’associazione garantisce l̵= 7;iscrizione gratuita, la polizza assicurativa, il servizio navetta per la Caserma Forestale del Gariglione.

L’associazione declina ogni responsabilità per eventuali= danni a cose e a persone nel corso della manifestazione non coperte dalla predetta polizza assicurativa.

&= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; FIRMA<= /o:p>

&= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; &nbs= p; &= nbsp; …&= #8230;…………………………= ;…….

= &nb= sp; = &nb= sp; =

Firma del genitore o di chi ne fa le veci (*)

= &nb= sp; = &nb= sp; = &nb= sp; ………………………̷= 0;………………..

(*) Per i partecipanti minorenni. AUTORIZZO IL TRATTAMENTO DEI D= ATI PERSONALI AI SENSI DELLA LEGGE 675/97

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