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Formulário de inscrição Brevet 200 km's Clube Audax Bagé
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Nome completo
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Apelido
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Data de nascimento
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Idade
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Sexo
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Tipo sanguíneo
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RG
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CPF
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Número ACP
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Em@il de contato
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Site ou blog
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Site de fotos
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Site de vídeos
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Telefones de contato com DDD
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Endereço de correspondência
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Bairro
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CEP
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Cidade / Estado
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Quantas provas de Audax / Randonée já fez?
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Algum problema físico?
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Plano de saúde
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Contato em caso de emergência:
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Responsável
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Grau de parentesco do responsável
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CPF / RG do responsável
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Situação de pagamento
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