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INSCRIPTION GNMHB 2020/2021
Afin d'initier votre licence pour la saison 2020/2021 veuillez remplir le formulaire ci dessous
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NOM
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PRÉNOM
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DATE DE NAISSANCE
MM
/
DD
/
YYYY
LIEU DE NAISSANCE
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ADRESSE
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CODE POSTAL
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VILLE
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MAIL Licencié
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TÉLÉPHONE Licencié
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MAIL PARENT 1
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TÉLÉPHONE PARENT 1
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MAIL PARENT 2
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TÉLÉPHONE PARENT 2
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CLUB PRÉCÉDENT
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TAILLE MAILLOT SELECT
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TAILLE SHORT SELECT
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POINTURE
*
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TAILLE MAILLOT POLO OU TEE SHIRT DIRIGEANT
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TAILLE (CM)
*
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POIDS
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