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INSCRIPCIÓ. CLUB CICLISTA DEPORTES BALAGUER DE BENICARLÓ DADES PERSONALS NOM I COGNOMS ___________________________________________________________ D.N.I. _________________ ADREÇA POSTAL Carrer, Plaça, Avinguda ____________________________________________ ___________ Municipi __________________________ Codi Postal ____________ e-correu i teléfon/s ___________________________________________________ _______ DADES PER A LA DOMICILIACIÓN BANCARIA NÚMERO DE COMPTE MODALITAT/S QUE PRACTICA CARRETERA MUNTANYA BMX AUTORITZACIÓ Per la prsent autoritzo al Club Ciclista Deportes Balaguer de Benicarló a que m´envien informació sobre la seua activitat i convocar-me als actes que organitza SIGNATURA: _______________________

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Ficha Javier3

  • 1. INSCRIPCIÓ. CLUB CICLISTA DEPORTES BALAGUER DE BENICARLÓ DADES PERSONALS NOM I COGNOMS ___________________________________________________________ D.N.I. _________________ ADREÇA POSTAL Carrer, Plaça, Avinguda ____________________________________________ ___________ Municipi __________________________ Codi Postal ____________ e-correu i teléfon/s ___________________________________________________ _______ DADES PER A LA DOMICILIACIÓN BANCARIA NÚMERO DE COMPTE MODALITAT/S QUE PRACTICA CARRETERA MUNTANYA BMX AUTORITZACIÓ Per la prsent autoritzo al Club Ciclista Deportes Balaguer de Benicarló a que m´envien informació sobre la seua activitat i convocar-me als actes que organitza SIGNATURA: _______________________