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Inscriptions 2023-2024 Groupe Gym adulte
Jeudi 19h30-21h30
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NOM
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Prénom
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DATE DE NAISSANCE
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YYYY
NUMERO AVS
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NATIONALITE
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ADRESSE POSTALE
Numéro + Rue
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NPA + Ville
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COORDONNEES
TELEPHONE 1
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MAIL 1
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Profession
INFORMATIONS SANTE
Allergies, diabéte, informations importantes pour les entraîneurs
informations particulières
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Nom et numéro assurance complémentaire
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SIGNATURE
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SIGNATURE
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