Trial Card | Asi Torino

Trial Card

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Nome

Nome

Cognome

Società di Appartenenza

indicare la società per la quale si è tesserati

Indirizzo

Indirizzo (linea 1)

seconda riga per indirizzo

Località

Stato / Provincia / Regione

Codice postale

Nazione

Sesso

M
F

Località di Nascita

Data di nascita

Email

Codice Fiscale

scrivere in maiuscolo, senza spazi fra un carattere e l'altro

Telefono

Tipologia Assicurativa

MA

Scadenza visita medica

Dichiaro che il certificato comprovante la visita medica sportiva e l'assenso alla pratica del motociclismo per i minorenni sono custoditi presso gli archivi del motoclub

SI

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