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{"sheet":"Feuil1","index":0,"n_rows":74,"n_cols":59,"rows_kept":74,"cut":false,"hidden":false,"merged":[[34,6,34,30],[45,31,45,40],[68,1,68,27],[45,16,45,25],[61,3,62,55],[68,29,69,55],[38,37,38,40],[58,1,58,55],[60,1,60,26],[45,41,45,44],[40,9,40,31],[38,27,38,36],[38,12,38,21],[38,22,38,26],[36,20,36,48],[45,26,45,30],[36,7,36,11],[43,19,43,41],[33,6,33,30],[0,1,10,14],[28,1,29,4],[7,38,7,53],[1,37,1,55],[2,38,2,53],[3,38,3,53],[4,38,4,53],[6,38,6,53],[25,1,26,4],[28,33,28,55],[11,1,14,55],[25,5,26,31],[19,34,22,55],[31,11,31,21],[8,42,8,56],[1,18,6,36],[7,18,10,36],[31,1,31,10],[28,5,29,31],[25,44,25,46],[15,8,15,48]]}
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Association Sportive Noiseraie Champy"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Gymnase de la Butte Verte "]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"5 Boulevard du Champy-Richardets"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"93160 Noisy Le Grand"]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Contact : Raphael VESSIER"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Tel. : 06 87 95 09 42"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Courriel : ",null,null,null,null,"inscription@grimpeanoisy.fr"]
[]
[]
[null,"Bulletin d'Adhésion \"Adulte\""]
[]
[]
[]
[null,null,null,null,null,null,null,null,"Adhérents nés en 1999 et avant ."]
[]
[null,null,null,null,null,null,null,null,null,"Les cases",null,null,null,null,null,"  ci-dessous indiquent une option. Elles sont à cocher selon l'option choisie."]
[]
[null,null,null,"3 créneaux horaires sont ouverts aux adultes",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Les créneaux dédiés à l'initiation se situent les mêmes jours, dans la  première heure et demi et ce jusqu'à la toussaint"]
[]
[null,null,"Lundi, Jeudi de 19h à 22h et mercredi de 19h30 à 22h"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[null,null,null,null,null,null,null,null,null,null,null,"(A remplir en majuscules)"]
[]
[null,"NOM :"]
[]
[]
[null,"Pénom :"]
[]
[]
[null,"Date de naissance : ",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[]
[null,"Adresse :"]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(*) Chèque à libeller à l'ordre de AS Noiseraie Champy"]
[]
[null,"Code postal :",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"Ville : "]
[]
[null,"N° de téléphone domicile :",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," portable :"]
[]
[null,"Adresse e-Mail :"]
[]
[]
[null,"Personne à contacter en cas d'accident :",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(Indiquer le nom prénom)"]
[]
[null,"joignable au :",null,null,null,null,null,"Téléphone domicile :",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null," portable :"]
[]
[null,"En signant ce bulletin d'adhésion : "]
[null,"1°) je reconnais :"]
[null,"- être informé qu'aucun remboursement ne sera effectué, "]
[null,"- avoir reçu une notice d'assurance et en avoir pris connaissance avant d'adhérer."]
[null,"- avoir reçu une notice relative à la fourniture, selon le cas, d'un certificat médical de moins d'un an ou d'une attestation et après avoir"]
[null,null,"répondu au questionnaire santé, fournir en conséquence :",null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,0]
[]
[null,"2°) j’autorise l’ASNC à prendre, détenir et diffuser mon image sous quelque forme de support que ce soit. Les images sont"]
[null,null,"acquises définitivement au profit de l’ASNC quelle que soit la période de leur utilisation et sans aucun paiement."]
[null,"3°) je m'engage à  : "]
[null,"- respecter le règlement intérieur de l'association et des installations sportives utilisées"]
[null,"- participer aux séances d'initiation sur les créneaux dédiés en vue d'acquérir mon autonômie sur SAE"]
[null,"4°) je souhaite recevoir la Newsletter de l'ASNC "]
[null,"5°) Le dossier d'inscription complet (**) comprend :"]
[null,null,null,"- Le présent bulletin d'adhésion dûment complété puis imprimé, daté et signé. (La pré-inscription est nécessaire en renvoyant par mail ce bulletin en format Excel à inscription@grimpeanoisy.fr)"]
[]
[null,null,null,"- deux photos d'identité au format 35 mm X 45 mm"]
[null,null,null,"- deux enveloppes timbrées à mon adresse domiciliaire"]
[null,null,null,"- le chèque de cotisation."]
[null,null,null,"- l'attestion ou le certificat médical"]
[]
[null,"Date et Signature "]
[]
[]
[]
[]
[null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,null,"(**) Seul les dossiers complets seront pris en compte."]

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