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SANBERNRACE?2013?
MODULO?DI?ISCRIZIONE??
NOME?SQUADRA:?
COMPONENTI??SQUADRA:?
??????NOME?E?COGNOME?(STAMPATELLO)???????????????????????????DATA?E?LUOGO?DI?NASCITA???????????????????????????????????FIRMA?
?
1.?_____________________________???????????????_______________________________?????????????______________?
?
2.______________________________???????????????_______________________________?????????????______________?
?
3.______________________________????????????????_______________________________?????????????_____________?
?
4._______________________________???????????????_______________________________?????????????_____________?
?
5.________________________________??????????????_______________________________?????????????____________?
?
6._________________________________??????????????_______________________________????????????____________?
?
RICEVUTA?PAGAMENTO?
?
SQUADRA:?________________________?
?
10€?x???____?????=????????_______?
?
Carmagnola,?23/09/2013?

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