Of nº 199 - D Árb - Federação Mineira de Futsal

Propaganda
Confederação Brasileira de Futsal
Fundada em 15 de Junho de 1979
FUTSAL - Esporte genuinamente brasileiro
FICHA DE INSCRIÇÃO DE ATLETA
Nome:
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Nacionalidade:
Filiação:
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Natural de:
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Data de Nascimento:
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Cart. De Identidade::
UF:
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Data da solicitação da Inscrição:
DATA
e-mail:
Telefone:
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FOTO
3x4
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CPF:
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ANO
Apelido:
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Residência:
Cidade:
Inscr. Nº ________________
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Assinatura do Atleta:
CLUBE
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FEDERAÇÃO
O atleta signatário declara, sob as penas da lei, que todas as informações e dados aqui consignados expressam a verdade.
Rua Coronel Ferraz, 52 - Edifício Dona Bela - Bloco B - Fortaleza – Ceará – Brasil – CEP: 60.060-150
Tel.: 55.85.3533.8300 – Fax: 55.85.3253.6425 – E-mail: [email protected]
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