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-MASSA-
                          18-22/25-29 GIUGNO 2012

NOME __________________________________________________
COGNOME ______________________________________________
RESIDENTE IN VIA _______________________________________
CITTA’ ____________ PROV. __________ (    )
TEL. 	 ______________________________________
      ISCRITTO ASD ACADEMY MASSESE JUNIOR
      ISCRITTO ACD TIRRENIA CALCIO
      ISCRITTO ALTRA SCUOLA CALCIO _________________________
E-MAIL _____________________________________
INFORMAZIONI GENERALI PER ISCRIZIONE E PAGAMENTO:
FORME DI PAGAMENTO:
€ 342,00 (ENTRO IL 30 APRILE 2012)
€ 361,00 (ENTRO IL 15 MAGGIO 2012)
€ 380,00 (ENTRO 1° GIUGNO 2012)
- BONIFICO BANCARIO: IBAN IT39 T010 0513 6000 0000 0000 800, BNL agenzia di Massa, INTESTATO A:
A.S.D. ACADEMY MASSESE JUNIOR (CAUSALE - QUOTA ISCRIZIONE J. C. TRAINING - MASSA).
- ASSEGNO CIRCOLARE INTESTATO A: A.S.D. ACADEMY MASSESE JUNIOR
- RIMESSA DIRETTA IN SEGRETERIA: (PREVIO APPUNTAMENTO).
INDICARE PERIODO PRESCELTO (BARRANDO LA RELATIVA CASELLA):
      18-22 GIUGNO 2012
      25-29 GIUGNO 2012
ESIGENZE PARTICOLARI DOCUMENTI DA ALLEGARE: INDICARE EVENTUALI ALLERGIE O
INTOLLERANZE ALIMENTARI: …………………………………………………………………………………..
INDICARE ETA’ DEL RAGAZZO ________ (ANNI) E SE SEGUE UNA CURA MEDICA:
      NO
      SI SPECIFICHI:………………………..………………………………
DOCUMENTI DA ALLEGARE:
• RICEVUTA DEL PAGAMENTO DELLA QUOTA D’ISCRIZIONE.
• Bonifico: IBAN IT39 T010 0513 6000 0000 0000 800, BNL agenzia di Massa (CAUSALE QUOTA ISCRIZIONE J.
   C. TRAINING - MASSA).
• CERTIFICATO MEDICO (sana e robusta costituzione per attività sportiva non agonistica).
• FOTOCOPIA DEGLI EVENTUALI CERTIFICATI DI VACCINAZIONE OBBLIGATORI.
• 2 FOTO TESSERA.
• STATO DI FAMIGLIA O AUTODICHIARAZIONE.
• FOTOCOPIA DEL TESSERINO SANITARIO.
• FOTOCOPIA DOCUMENTO D'IDENTITA'.
LA SCHEDA GENERALE DI ISCRIZIONE VERRA’ COMPILATA PRESSO LA NOSTRA SEGRETERIA ALLEGANDO
TUTTA LA DOCUMENTAZIONE RICHIESTA.

RIFERIMENTI TELEFONICI E E-MAIL. Info@asdmassesejunior.it
+39.346.7115685
+39.347.6003547

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Jc training 2012-info

  • 1. -MASSA- 18-22/25-29 GIUGNO 2012 NOME __________________________________________________ COGNOME ______________________________________________ RESIDENTE IN VIA _______________________________________ CITTA’ ____________ PROV. __________ ( ) TEL. ______________________________________ ISCRITTO ASD ACADEMY MASSESE JUNIOR ISCRITTO ACD TIRRENIA CALCIO ISCRITTO ALTRA SCUOLA CALCIO _________________________ E-MAIL _____________________________________ INFORMAZIONI GENERALI PER ISCRIZIONE E PAGAMENTO: FORME DI PAGAMENTO: € 342,00 (ENTRO IL 30 APRILE 2012) € 361,00 (ENTRO IL 15 MAGGIO 2012) € 380,00 (ENTRO 1° GIUGNO 2012) - BONIFICO BANCARIO: IBAN IT39 T010 0513 6000 0000 0000 800, BNL agenzia di Massa, INTESTATO A: A.S.D. ACADEMY MASSESE JUNIOR (CAUSALE - QUOTA ISCRIZIONE J. C. TRAINING - MASSA). - ASSEGNO CIRCOLARE INTESTATO A: A.S.D. ACADEMY MASSESE JUNIOR - RIMESSA DIRETTA IN SEGRETERIA: (PREVIO APPUNTAMENTO). INDICARE PERIODO PRESCELTO (BARRANDO LA RELATIVA CASELLA): 18-22 GIUGNO 2012 25-29 GIUGNO 2012 ESIGENZE PARTICOLARI DOCUMENTI DA ALLEGARE: INDICARE EVENTUALI ALLERGIE O INTOLLERANZE ALIMENTARI: ………………………………………………………………………………….. INDICARE ETA’ DEL RAGAZZO ________ (ANNI) E SE SEGUE UNA CURA MEDICA: NO SI SPECIFICHI:………………………..……………………………… DOCUMENTI DA ALLEGARE: • RICEVUTA DEL PAGAMENTO DELLA QUOTA D’ISCRIZIONE. • Bonifico: IBAN IT39 T010 0513 6000 0000 0000 800, BNL agenzia di Massa (CAUSALE QUOTA ISCRIZIONE J. C. TRAINING - MASSA). • CERTIFICATO MEDICO (sana e robusta costituzione per attività sportiva non agonistica). • FOTOCOPIA DEGLI EVENTUALI CERTIFICATI DI VACCINAZIONE OBBLIGATORI. • 2 FOTO TESSERA. • STATO DI FAMIGLIA O AUTODICHIARAZIONE. • FOTOCOPIA DEL TESSERINO SANITARIO. • FOTOCOPIA DOCUMENTO D'IDENTITA'. LA SCHEDA GENERALE DI ISCRIZIONE VERRA’ COMPILATA PRESSO LA NOSTRA SEGRETERIA ALLEGANDO TUTTA LA DOCUMENTAZIONE RICHIESTA. RIFERIMENTI TELEFONICI E E-MAIL. Info@asdmassesejunior.it +39.346.7115685 +39.347.6003547