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INSCRIPCIÓN COMO SOCIO/A DE AFIM21
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Puede realizar el pago de la cuota indicada en el Nº de cuenta de AFIM21
"la Caixa" ES79 2100 2033 53 0200110959
Nombre
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Apellido 1
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Apellido 2
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DNI
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Teléfono
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E-mail
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F. Nacimiento
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MM
/
DD
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YYYY
Dirección
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C.P.
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Localidad
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Ciudad
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Tipo de pago
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Anual
Tipo de Socio
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Familia
Individual
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