|
Anmeldung fuer SAM 50 km / 35 km / 10 km |
|
| 13.9.2008 | |
| Anmeldung: | SAM 50 km SAM 35 km SAM 10 km |
| Name: | _____________________________________ |
| Vorname: | _____________________________________ |
| Geburtsjahr: | ____________ |
| Geschlecht: | M F |
| Adresse: | _____________________________________ |
| _____________________________________ | |
| _____________________________________ | |
| Land: | _____________________________________ |
| Klub / Organisation.: | _____________________________________ |
| Telephon: | _____________________________________ |
| E-mail: | _____________________________________ |
| Datum: | ______________________ |
| Unterschrift: | ______________________ |