ࡱ>  "'`h,bjbjLULUC.?.?8 N N N N D   %''''''h 'E ] @ ' l   % % `ZN +%0+l  ''     KARTA ZGAOSZENIOWA  STARTOWA III Pieszego Rajdu na Orientacj filmowa  Wiosenna NawaBnica 16 kwietnia 2011 Imi i nazwisko: ................................ Data urodzenia: ................................ PeBny adres zameldowania (miasto, kod pocztowy, ulica): ............................................................................................... ................................................................................ Telefon komrkowy: ................................ E-mail: ................................ Wybieram tras: - podstawow (ok. 36-40 km) - start w Kaliszu Pomorskim * - krtk (ok. 18 km) - start w Kaliszu Pomorskim * - krtk (ok. 18 km) - start w Tucznie * Bd startowa w rajdzie: - sam (-a) * - w zespole z ................................................................................................* Chc przenocowa na mecie rajdu (bezpBatnie dla osb spoza gmin Kalisz Pomorski i Tuczno): - na B|ku w pokoju kilkuosobowym * - na podBodze w sali zbiorowej na wBasnej karimacie * - na zewntrz we wBasnym namiocie * Wyra|am zgod na start w Rajdzie III filmowa  Wiosenna NawaBnica 2011. O[wiadczam, i| zapoznaBem si z Regulaminem Rajdu i zobowizuj si do jego przestrzegania. Jestem [wiadomy wysiBku, jaki musz podj, niespodzianek i utrudnieD jakie mog napotka na trasie oraz mo|liwych zmiennych warunkw atmosferycznych. W rajdzie startuj na wBasn odpowiedzialno[. Na udziaB w rajdzie pozwala mi mj stan zdrowia. Wyra|am zgod na wykorzystanie i przetwarzanie swoi<>@ իfQ@!h&5B*OJQJ\^Jph)h&5B*CJOJQJ\^JaJph5jh5B*OJQJU\^JmHnHphu)hLQ5B* CJ OJQJ\^JaJ ph3)h_Q5B* CJ OJQJ\^JaJ ph3)h&5B* CJ OJQJ\^JaJ ph3)h_Q5B* CJOJQJ\^JaJph3)hLQ5B* CJOJQJ\^JaJph3)h&5B* CJOJQJ\^JaJph3<H  o   z 2 f b`L$7$8$H$`a$gdfK 7$8$H$gd3 7$8$H$gdB 7$8$H$ $7$8$H$a$h,  F h   n o   '    , 4 v x ݻݕ̄sssbsJss/hJh3 5B*CJ OJQJ\^JaJ ph!h/:5B*OJQJ\^Jph!h3 5B*OJQJ\^Jph!hg5B*OJQJ\^Jph)h&5B*OJQJ\^JmHphsH!h/5R5B*OJQJ\^Jph!h[5B*OJQJ\^Jph!h&5B*OJQJ\^Jph!hB 5B*OJQJ\^Jph!h_Q5B*OJQJ\^Jph . 0 2 b f j p z | ~ <\^`bݴş}ݎlTl}lT@'hN1hfK5B*OJQJ\^Jph/hJhfK5B*CJ OJQJ\^JaJ ph!hfK5B*OJQJ\^Jph!hN15B*OJQJ\^Jph!h&5B*OJQJ\^Jph)h3 5B*OJQJ\^JmHphsH!hg5B*OJQJ\^Jph/hJh3 5B*CJ OJQJ\^JaJ ph!h3 5B*OJQJ\^Jph!h/:5B*OJQJ\^Jphb,\^zXZ\`lp־oZEZEZoEoZ)h{ih_QB*CJOJQJ^JaJph)h{ihfKB*CJOJQJ^JaJph)h{ih&B*CJOJQJ^JaJph!h_Q5B*OJQJ\^Jph/hJhS,5B*CJ OJQJ\^JaJ ph!hg5B*OJQJ\^Jph/h/:h/:5B*CJOJQJ\^JaJph/h/:hS,5B*CJOJQJ\^JaJph!hS,5B*OJQJ\^Jph\^"#$|$$%.%2%>%%&&&F'\'j''~p~pf[P[Eh_Q5OJQJ^JhO5OJQJ^Jh&5OJQJ^Jh&OJQJ^Jh&B*OJQJ^Jph#h&B*OJQJ^JmH phsH 1h{ih&B*CJOJQJ^JaJmH phsH )h{ih{iB*CJOJQJ^JaJphU)h{ih_QB*CJOJQJ^JaJph)h{ihfKB*CJOJQJ^JaJph)h{ih&B*CJOJQJ^JaJphch danych osobowych przez organizatorw rajdu, do celw zwizanych z przygotowaniem i przeprowadzeniem rajdu. (zgodnie z Ustaw z dn. 29.08.1997 r. o Ochronie Danych Osobowych, Dz. Ust. Nr 133). Wyra|am zgod na otrzymywanie informacji zwizanych z przygotowaniem i przeprowadzeniem rajdu, drog elektroniczn lub poczt tradycyjn, zgodnie z ustaw z dnia 18.07.2002 r. (Dz. U. z 2002r. Nr 144, poz.1204). Data: ..................................... Podpis: .......................................... = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = = WypeBnion Kart ZgBoszeniow nale|y przesBa (najpzniej do dn. 10 kwietnia 2011): - na adres e-mail:  HYPERLINK "mailto:kp@arsobatravel.pl" kp@arsobatravel.pl lub - poczt tradycyjn na adres: Jerzy Arsoba, ul. Brzozowa 4 / 7, 78-540 Kalisz Pomorski.  Mo|na tak|e zgBasza uczestnictwo telefonicznie: Joanna Urban tel. kom. 603 405 550 e-mail: joanna@arsobatravel.pl Jerzy Arsoba tel. kom. 601 725 390 e-mail: jerzy@arsobatravel.pl Wszelkie informacje znajduj si na stronach serwisu www.arsobatravel.pl oraz pod w/w numerami telefonw Uwaga: Podpis na Karcie ZgBoszeniowej  Startowej Uczestnik zBo|y dopiero na starcie rajdu. * niepotrzebne skre[li (wykasowa) L#.%0%2%&&(&&'2(:(((T))*&+f+h+ ,h,gdO7$8$H$ $7$8$H$a$ $7$8$H$`a$'''''''(( (.(0(:(t(x((((T)l)t))))̾̾yaPBPBPhOCJOJQJ^JaJ hOhOCJOJQJ^JaJ.jhCJOJQJU^JaJmHnHuh_QCJOJQJ^JaJh&0JCJOJQJ^JaJ)jh&CJOJQJU^JaJ#jh&CJOJQJU^JaJh&CJOJQJ^JaJ#hJh&5CJOJQJ^JaJh&5OJQJ^Jh_Q5OJQJ^JhO5OJQJ^J)) **>*X*******$+&+d+f+h+t+ ,",$,ŷũũśpbK: hlePh&CJ OJQJ^JaJ ,hJh&5B*CJ OJQJ^JaJ phhB h&>*OJQJ^JhB h&5>*OJQJ^Jh&OJQJ^J hh&CJOJQJ^JaJh+@CJOJQJ^JaJhCJOJQJ^JaJh_QCJOJQJ^JaJh&CJOJQJ^JaJhOCJOJQJ^JaJ hOhOCJOJQJ^JaJhCJOJQJ^JaJ$,N,f,h, hlePh&CJOJQJ^JaJhJOJQJ^JhlePh&OJQJ^J/0P/ =!"S#7$7% F¼g]^4:JFIFHHExifMM*bj(1r2iHHAdobe Photoshop CS Windows2011:03:14 22:06:53&(.HHJFIFHH Adobe_CMAdobed            k" ? 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