MODULO ISCRIZIONE .pdf
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MODULO ISCRIZIONE
Da inviare entro il 2 aprile 2016 al seguente indirizzo e-mail:
pl.sicurezzastradale@gmail.com
COGNOME
_________________________________________
NOME
_________________________________________
DATA DI NASCITA
___________________
RESIDENTE A _________________________________________
PATENTE N.
___________________ RILASCIATA IL _________
ISTITUTO SCOLASTICO (nome istituto __________________)
NEOPATENTATO
N
e
o
p
a
t
e
n
t
a
t
o
GIORNO PRESUNTO DI PARTECIPAZIONE
Venerdì 8 aprile
9/13
14/17
Sabato 9 aprile
9/13
14/17
Domenica 10 aprile
9/12
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