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ELEMENTA - IRHA MATURITY 2021
REGISTRAZIONE INDIVIDUALE - INDIVIDUAL REGISTRATION FORM
Vi pregiamo di compilare questo modulo per ogni membro della tua squadra
Please fill in this form for every member of your team
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* Indicates required question
Nome Scuderia Gruppo Prenotazione/ Team name
*
Your answer
Cognome/surname
*
Your answer
Nome/ first name
*
Your answer
Indirizzo/address
*
Your answer
Telefono/Telephone
*
Your answer
E-mail
*
Your answer
Funzione/function
*
Cocorrente/rider
Istruttore/coach
Groom
Proprietario cavallo/horse owner
Autista van/horsetruck driver
Genitore/parent
Accompagnatore Para atleti/accompanist para riders
staff
Socio IRHA
Negli ultimi 15 giorni hai avuto contatto con qualcune che representava sintomi come tosse e/o febbre? In the last 15 days did you have contact with a person representing a cough and/or fever?
*
Si - Yes
No
Hai avuto une dei seguenti sintomi ? Did you experience any of the following symptoms ?
*
Temperatura oltre i 37,5°C - Temperature above 37,5°C (99,5°F) SI - YES
Temperatura oltre i 37,5°C - Temperature above 37,5°C (99,5°F) NO
Problemi respiratori - breathing problems SI - YES
Problemi respiratori - breathing problems NO
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