Ç À
ß Â Ê À
Íà ó÷àñòèå
â ×åìïèîíàòå Ðîññèè ïî
ñïåëåîòóðèñòñêîìó ìíîãîáîðüþ
Îò êîìàíäû___________________________________________________________________________
Ãîðîä (Îáëàñòü) _______________________________________________________________________
Îðãàíèçàöèÿ , êëóá_____________________________________________________________________
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Ô. È. Î. / ïîëíîñòüþ/ |
ãîä ðîæä. |
îáÿçàííîñòè â äåëåãàöèè |
ñïåëåî èëè ñóäåéñêàÿ êâàëèôèêàöèÿ /ïå÷àòü êëóáà èëè øòàìï ÌÊÊ / |
âèçà âðà÷à |
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Ê ñîðåâíîâàíèÿì äîïóùåíû ________÷åëîâåê
Ì. Ï. Âðà÷_________/_____________/
ïîäïèñü
Äàííûå çàÿâêè
ïîäòâåðæäàþ:
Ðóêîâîäèòåëü îðãàíèçàöèè Ì. Ï.
________________/_______________/
ïîäïèñü
Ïðåäñòàâèòåëü êîìàíäû ________________/_______________/
ïîäïèñü
Çíàíèå ïðàâèë áåçîïàñíîñòè íà ñêàëàõ
è áåçîïàñíîñòü ëè÷íîãî ñíàðÿæåíèÿ
ó÷àñòíèêîâ êîìàíäû ïîäòâåðæäàþ:
Êàïèòàí êîìàíäû _________________/_______________/
ïîäïèñü