Dossierlido 2011 (kopia)

Dossier Sélections LIDO 2010 - 2011 1/13

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Photo d’identité obligatoire

(à inscrire en majuscules) NOM & PRENOM : ----------------------------------------------------------------------- Né(e) le : ----/------/---------- Taille : --------------------- Poids : -------------- Nationalité(s) : ----------------------------------------------------------------------------- Diplôme le plus élevé obtenu : ---------------------------------------------------------- Date d’obtention de ce diplôme : -----/-----/----------- Sinon, Niveau de diplôme non validé : ---------------------------------------------- Adresse COMPLETE : ------------------------------------------------------------------ ------------------------------------------------------------------------------------------------- Pays : ------------------------------------ Tél. : ------------------------------- Port : ------------------------------------- Email : ------------------------------------------------------------


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