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INSCRIPCION AL PROGRAMA 2012
Recuerde la fecha de inscripción estará vinculada a la fecha de pago / remember the date of registration will be linked to the payment date
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Nombre / Name
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Apellidos / Surname
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Nombre espiritual / Spiritual name
Si tiene / If any
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Dirección postal / Postal address
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Cod. Postal y comunidad / Zip Code
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País / Nationality
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Teléfono de contacto / Telephone number
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poner prefijo / Prefix
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Correo electrónico / Email
*
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fecha de nacimiento / date of birth
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dd-mm-aaaa / dd-mm-yyyy
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Fecha del ingreso / Deposite date
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dd-mm-aaaa / dd-mm-yyyy
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Código del banco y oficina del ingreso / Bank code and office code
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BBBB OOOO
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