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FICHA DE INSCRIPCIÓN
Declaración Jurada
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APELLIDO Y NOMBRE
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DNI
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DOMICILIO (direccion, Nº altura, localidad)
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NÚMERO DE TELEFONO/CELULAR
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TELEFONO
Y NOMBRE ALTERNATIVO DE EMERGENCIA (obligatorio):
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AFECCIONES MEDICAS:
TOMA
de MEDICAMENTOS:
ALERGIAS:
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APELLIDO Y NOMBRE
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DNI
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