Autor: Ana Prata | Publicado: 2014-05-05T08:31:00-07:00





Inscrições
&nbsp;para Muay Thay


Categoria
Masculino – 1 atleta por categoria


 

  
  
Prazo
  de Inscrição 05 de MAIO 2014

  
  
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Categorias

Marque
  com um X sua categoria

 

  
  
Nome Completo
  (letra legível)

  
  
Peso

  
  
Idade

  
  
Amador

  
  
Avançado

 

  
  
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45Kg

  
  
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48Kg

  
  
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51Kg

  
  
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54Kg

  
  
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57Kg

  
  
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60Kg

  
  
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63,5Kg

  
  
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67Kg

  
  
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71Kg

  
  
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75Kg

  
  
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81Kg

  
  
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86Kg

  
  
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91Kg

  
  
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&nbsp;


TERMO
DE RESPONSABILIDADE


&nbsp;


Declaro para os devidos fins, ter conhecimento
do estado físico, apto para a competição, ciente que cada atleta é responsável
por acidentes ou problemas de saúde advinda da sua participação, não cabendo
nenhuma responsabilidade à ASSOCIAÇÃO DE LIGA INDEPENDENTE DE ARTES MARCIAIS
DESPORTIVAS CULTURAL DO ESTADO DE SÃO PAULO e seus representantes.


&nbsp;


São Paulo,
________de _______________ 2014.


&nbsp;


Assinatura
do responsável: ______________________________________


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<b
    style='mso-bidi-font-weight:normal'><span style='font-size:8.0pt;
    line-height:115%;font-family:"Century Gothic","sans-serif"'>Instruções:<span
    style='font-size:8.0pt;line-height:115%;font-family:"Century Gothic","sans-serif"'>
    Enviar essa inscrição devidamente preenchida para e-mail <a
    href="mailto:jeremiasevento@live.com.br"><span style='font-size:8.0pt;
    line-height:115%;font-family:"Century Gothic","sans-serif"'>jeremiasevento@live.com.br<span
    style='font-size:8.0pt;line-height:115%;font-family:"Century Gothic","sans-serif"'>
    Para validar sua inscrição efetuar o depósito 

<span style='font-size:9.0pt;mso-bidi-font-size:11.0pt;
    line-height:115%;font-family:"Arial","sans-serif"'>Banco Itaú

<span style='font-size:9.0pt;mso-bidi-font-size:11.0pt;
    line-height:115%;font-family:"Arial","sans-serif"'>Agência: 0152

<span style='font-size:9.0pt;mso-bidi-font-size:11.0pt;
    line-height:115%;font-family:"Arial","sans-serif"'>C/C: 65508-0

&nbsp;

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<![endif]>
<![endif]--><!--[if !vml]--><img alt="Caixa de texto: Instruções: Enviar essa inscrição devidamente preenchida para e-mail jeremiasevento@live.com.br Para validar sua inscrição efetuar o depósito 
Banco Itaú
Agência: 0152
C/C: 65508-0

" height="193" src="file:///C:/Users/aprata/AppData/Local/Temp/msohtmlclip1/01/clip_image001.png" v:shapes="Caixa_x0020_de_x0020_texto_x0020_1" width="246" /><!--[endif]-->RG do
responsável:_________________________________________