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Inscription Formation JFA1 du 21 et 22/01 2023
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Nom
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Prénom
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Date de naissance
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Lieu
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Téléphone Portable
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Mail
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Renseignement FFESSM
N° Licence FFESSM 2022/23
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Niveau Apnée
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Catégorie Assurance FFESSM
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Club d'Appartenance
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N° Club
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Date du dernier Certificat médical
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Documents à fournir
Photocopie du certificat médical de moins de 1 an
Photocopie du niveau d'apnée (Minimum Apnéiste Piscine)
Photocopie RIFAA
Chèque de 25 € à l'ordre de la CRA Occitanie
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