FICHA DE INSCRIPCIÓN PARA PARTICIPAR DEL II ESNA

Dibujo

22, 23, 24/09/2009 – São Paulo – Brazil

FICHA DE INSCRIÇÃO – FORMULAIRE D’INSCRIPTION – REGISTRATION FORM

A enviar até 23/08/09 para:   A renvoyer au plus tard le 23/08/09 à:    To be returned by 23/08/09 to:

e-mail: internacional.ctb@portalctb.org.br internacional.ctb@gmail.com

Phone / fax : +55 11. 31060700  + 55 11. 31066492

(escrever em MAIÚSCULAS / prière d’écrire en MAJUSCULES / please use BLOCK letters)
Apelido/nom/name (Sr./M./Mr) (Srª/Mme/Ms):

Nome próprio/Prénom/Forename:

Organização/Organisation:

Cargo / Fonction / Position:

Morada/Adresse/Address:

Nº do passaporte/ Nº du Passeport/ Passport Nº: …………………………………………………

Data de Nascimento/Date de Naissance/Date of Birth: …………………………………………

Nacionalidade/Nationalité/Nationality:

Data de Emissão/ Date d’Émission/Date of Issue…………………………………………………

Válido até/ Valable jusqu’au/ Valid until: ………………………………………………………

Chegada / Arrivée / Arrival                                            Partida / Départ / Departure

Data/Date                                                                          Data/Date

Horário / Heure / Time                                                    Horário / Heure / Time

Nº de vôo/ Nº du vol/ Flight                                             Nº de vôo/ Nº du vol/ Flight

Companhia/ Compagnie / Company                              Companhia/ Compagnie / Company

(TEL…………………………………….. FAXÊ………………………………………..

E-mail ……………………………………………..

INTERPRETATION:

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