Trial Card Multipla | Asi Torino

Trial Card Multipla

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Società di Appartenenza

INDICARE IL NIOME DELLA SOCIETA'

e-mail dove ricevere le card

indicare la mail dove ricevere le tessere

Nome Pilota N1

Nome

Cognome

Data di nascita

Tessera numero trial

Scadenza tessera trial

Scadenza visita medica in corso di validità

Nome Pilota N2

Nome

Cognome

Data di nascita

Tessera numero trial

Scadenza tessera trial

Scadenza visita medica in corso di validità

Nome Pilota 3

Nome

Cognome

Data di nascita

Tessera numero trial

Scadenza tessera trial

Scadenza visita medica in corso di validità

Dichiaro che il certificato comprovante la visita medica sportiva e l'assenso alla pratica del motociclismo per i minorenni sono custoditi presso gli archivi del motoclub

SI

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