Ficha de Inscrição MEIA MARATONA DA COMUNIDADE VILA SANTO ISIDORO BERILO MG
Autor: Berilo - Blog do Dênio | Publicado: 2014-08-21T16:50:00-07:00






MEIA
MARATONA DA COMUNIDADE VILA SANTO ISIDORO BERILO MG

FICHA
DE INSCRIÇÃO Nº ­­­­­_______

NOME:
____________________________________________________________

ENDEREÇO:
______________________________________________Nº _________

BAIRRO:
­­­­­­­­­­­­­______________________ CIDADE: __________________ UF: ________

CEP:____________
TELEFONE:_______________ E-MAIL:_____________________

DATA
DE NASCIMENTO: ____/____/______ IDADE: __________ SEXO: _________

NATURALIDADE:
_____________________ UF:_____ 

RG:
_________________ EXPEDIDOR: ___________ CPF: ____________________

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 z-index:251656704'/><![endif]--><!--[if !vml]--><!--[endif]-->CATEGORIAS:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; GERAL&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; BERILENSE&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 

&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;
TIPO: ______________________

Declaração:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; 

Confirmo
a minha inscrição na Meia Maratona Da Vila Santo Isidoro e declaro que estou em
plenas condições físicas e de saúde para disputar a prova, isentando a Prefeitura
Municipal de Berilo, Parceiros e Patrocinadores, em meu nome ou de herdeiros de
quaisquer acidentes que venha a sofrer antes, durante ou após o evento. Permito
o livre uso de meu nome e imagem para finalidades de divulgação do evento,
estando ciente dos padrões regulamentares da prova.

Berilo
MG, _________ de ____________ de 2014.



_______________________________________

Assinatura
do Atleta ou Responsável

....................................................................................................................................................

FICHA
DE INSCRIÇÃO Nº ­­­­­_______

NOME:
____________________________________________________________


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 z-index:251658752'/><![endif]--><!--[if !vml]--><!--[endif]-->CATEGORIAS:&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; GERAL&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; BERILENSE&nbsp;