





** Compilare in stampatello**



Mod.
19-I

2015-2016



Modulo di Tesseramento**








Il/la sottoscritto/a














Codice
fiscale*















Genitore/tutore
del minore







Cognome





Nome






nato/a




il 





C.F.
dell’atleta





Residente
in Via





Comune


 



Prov.
Cittadinanza






Tel.
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
disposizioni
del Ministero della Salute.
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