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Dossierlido 2011 (kopia)
1.
! ! ! ! ! !
"#! "$%&'! (#)*+#!,#-!.+*-!,/!(0+1/#!,#!23/43/-#! ! ! ! ! ! !!!!!!!!!!!!!!!"#$$%&'!()%*$+'%,-%#*!! ! ! !! ! ! ! ! ! ! ! !!!!!.#'/0-%#*!,'#1&$$%#**&22&! ! ! ! ! ! 3!2)%*%-%0-%4&!(&!20!5%22&!(&!6#72#7$&8!2&!9%(#!#74'&!$&$!,#'-&$!&*!:;<<=!>#7-&*7!,0'!20!'?@%#*!A%(%BCD'?*?&$! &-! 20! "E3F8! 2&! 9%(#! &$-! (&4&*7! (&,7%$! +&$! (&'*%G'&$! 0**?&$! 7*! 2%&7! ,'%4%2?@%?! (&! 20! 1#'/0-%#*! 0'-%$-%H7&!! &7'#,?&**&=! 90! (?/0'+I&! ,?(0@#@%H7&! (&! 2)?+#2&! ,'#1&$$%#**&22&! &$-! 07! $&'4%+&! (&! 2)0'-%$-&8! J! 20! '&+I&'+I&! ()7*&! $%@*0-7'&!&-!()7*&!07-I&*-%+%-?!0'-%$-%H7&=!K22&!$)0,,7%&!$7'!2&$!-&+I*%H7&$!(&!+%'H7&!&-!'&4%$%-&!2&!-I?L-'&8!20! (0*$&8! 2&$! 0'-$! ,20$-%H7&$! &-! -#7-&! 07-'&! 1#'/&! +'?0-%4&! $7$+&,-%M2&! ()%*127&*+&'! &-! ()&*'%+I%'! 2&$! ,'#,#$%-%#*$!0'-%$-%H7&$!(&!20!$+G*&!+#*-&/,#'0%*&8!$0*$!,&'('&!,#7'!07-0*-!20!$,?+%1%+%-?!(7!+%'H7&=!9&!9%(#! ,'%4%2?@%&!2)?+'%-7'&!,&'$#**&22&8!20!'&+I&'+I&!()7*!20*@0@&!+#',#'&2!,'#,'&!07!+#/?(%&*!(&!+%'H7&=! C0'-&*0%'&!(D*0/%H7&!(7!(?4&2#,,&/&*-!2#+028!2&!9%(#!$&!+0'0+-?'%$&!,0'!$&$!?+I0*@&$!04&+!2&$!0'-%$-&$!&-! +#/,0@*%&$! ,'#1&$$%#**&22&$! *?&$! (0*$! $&$! /7'$! N2&$! 3+'#$-%+I&$8! 20! +#/,0@*%&! :::8! 2&! O#7$-'#,I?(#*8! F'%(0+#/,0*D8!20!+#/,0@*%&!>%*@72%G'&8!P?-#8!2&!C&-%-!6'04&'$8!&-+=Q! ! ! "5!,675+89#!:6,5;3;01/#! 9)?+#2&! $)%*$+'%-! (0*$! 7*&! (D*0/%H7&! %**#40*-&! (7! $,&+-0+2&! +%'+0$$%&*=! 9)#MR&+-%1! (&! 2)?+#2&! &$-! (&! (D*0/%$&'!2&$!?2G4&$!J!20!'?02%$0-%#*!()7*!R&7*&!+%'H7&!(&!+'?0-%#*!,#'-&7'!(&!20*@0@&!#S!20!,&'1#'/0*+&!0! $0!,20+&8!2)0+-&7'!0!$#*!$&*$8!2&$!$,&+-0-&7'$!$#*-!,'?$&*-$=! ! 90!(?/0'+I&!,?(0@#@%H7&!$)0,,7%&!$7'!7*!-'%,-DH7&!+'?0-%1!01%*!()0/&*&'!2)?2G4&!J!T! !!"?+#74'%'!20!,0'-!(&!(?'%$#%'&!H7%!2)I0M%-&8!2&$!10%22&$!H7%!2&!+#/,#$&!,#7'!H7)%2!-'#74&!$0!$%*+?'%-?=! !! >)&*'%+I%'! (0*$! 2&$! -&+I*%H7&$! (7! /#74&/&*-! ,0'!7*&! ,'?,0'0-%#*! +#',#'&22&! &-! 4#+02&8! 7*&! 0+'#M0-%&! ('0/0-%H7&8!7*&!'&+I&'+I&!(0*$!2&$!(%11?'&*-$!-&''%-#%'&$!(&!20!@&$-7&22&!0'-%$-%H7&=! !! >&! $%-7&'! (0*$! $#*! 0'-! +%'+0$$%&*! +#//&! 7*! U!$,#'-%1! (&! I07-! *%4&07!V! #S! +I0+7*! (#%-! 0--&%*('&! 20! ,2?*%-7(&!(7!/#74&/&*-!R7$-&8!$0*$!/#(G2&!,'?(?1%*%!,0'!20!2#*@7&!I%$-#%'&!(7!+%'H7&=! ! 9&! +#',$! (&$! &*$&%@*0*-$! (D*0/%$&! 7*! &$,0+&! ,&'/0*&*-! (&! '?12&W%#*=! P2$! (?1%*%$$&*-! (&$! #7-%2$! ,?(0@#@%H7&$! ,&'-%*&*-$8! %*127&*+?$! ,0'! 20! '%+I&$$&! +72-7'&22&! ()I%&'! &-! ()07R#7'()I7%! -#7-! &*! @0'(0*-! 7*&! 1#'-&!+72-7'&!U!2%(#-%&**&!V=! P2! $)0@%-! -'G$! +20%'&/&*-! ()7*! ,0'+#7'$! (&! 1#'/0-%#*! ,27$! H7)7*! 0,,'&*-%$$0@&8! 07! +#7'$! (7H7&2! &$-! &*-'&,'%$&!20!'&+I&'+I&!()7*&!$%@*0-7'&!0'-%$-%H7&=!P2!&$-!'?@%!,0'!20!4#2#*-?!(&!+#/M%*&'!2&$!0,,'&*-%$$0@&$! Dossier Sélections LIDO 2010 - 2011 1/13
2.
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3.
! ! ! "#-!>+50-!,#!-8345+0*6! 90!1#'/0-%#*!&$-!@'0-7%-&=! 9)%*$-0220-%#*!&-!20!4%&!$7'!6#72#7$&!%*+#/M&*-!J!2)?-7(%0*-=!! 9)?+#2&!*)0$$7'&!*%!2)I?M&'@&/&*-8!*%!20!*#7''%-7'&=! !
Dossier Sélections LIDO 2010 - 2011 3/13
4.
! ! C!I!$%KL2$2K! ! ! !
(à inscrire en majuscules) ! ! Photo NOM & PRENOM : ----------------------------------------------------------------------- ! d’identité ! obligatoire Né(e) le : ----/------/---------- ! ! Taille : --------------------- Poids : -------------- ! ! Nationalité(s) : ----------------------------------------------------------------------------- ! ! Diplôme le plus élevé obtenu : ---------------------------------------------------------- ! ! Date d’obtention de ce diplôme : -----/-----/----------- ! ! Sinon, Niveau de diplôme non validé : ---------------------------------------------- ! ! Adresse COMPLETE : ------------------------------------------------------------------ ! ------------------------------------------------------------------------------------------------- ! ! Pays : ------------------------------------ ! ! Tél. : ------------------------------- Port : ------------------------------------- ! ! Email : ------------------------------------------------------------ ! ! ! E!M!N&OP.2$&L!($OQGK! ! !!K834#-!,#!80+1/#!>+61/#)*6#-! !!!!!!!!!!!R6+03,#-!! %/+6#!,#!45!>3+75*03)! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! ! SRK($."$2K!:+6-#)*6#!J!45!-64#8*03)!H!!!!!!!!!!BBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBBB! ! S0!%G&'!L&P!#*!ROKL&P!,/!3/!,#!45!:5+*#)50+#!H!IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII! ! Dossier Sélections LIDO 2010 - 2011 4/13
5.
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