Mérite sportif 2021 - Inscriptions

 

*Un formulaire par candidature

Mérite sportif des Trois-Chêne 2021

(attribution en 2022)
Société
Field is required!
Field is required!
Nom
Field is required!
Field is required!
Prénom
Field is required!
Field is required!
Adresse
Field is required!
Field is required!
Téléphone
Field is required!
Field is required!
Adresse email
Field is required!
Field is required!

Propose que le Mérite Sportif des Trois-Chêne soit décerné à :

SPORTIF/SPORTIVE - PERFORMANCE INDIVIDUELLE

Field is required!
Field is required!
Nom
Field is required!
Field is required!
Date naissance
Field is required!
Field is required!
Prénom
Field is required!
Field is required!
Tél/courriel
Field is required!
Field is required!
Domicile
Field is required!
Field is required!
NPA / commune
Field is required!
Field is required!
Sport pratiqué
Field is required!
Field is required!
Club / société
Field is required!
Field is required!
Ligue / catégorie
Field is required!
Field is required!

CLUB/SOCIETE - PERFORMANCE CLUB/EQUIPE

Field is required!
Field is required!
Club / société
Field is required!
Field is required!
Domicile
Field is required!
Field is required!
Équipe
Field is required!
Field is required!
Tél / courriel
Field is required!
Field is required!
NPA / commune
Field is required!
Field is required!
Sport pratiqué
Field is required!
Field is required!
Ligue / catégorie
Field is required!
Field is required!

PERSONNE - DEVOUEMENT

Field is required!
Field is required!
Nom
Field is required!
Field is required!
Date naissance
Field is required!
Field is required!
Prénom
Field is required!
Field is required!
Tél/courriel
Field is required!
Field is required!
Domicile
Field is required!
Field is required!
NPA / commune
Field is required!
Field is required!
Sport pratiqué
Field is required!
Field is required!
Club / société
Field is required!
Field is required!
Fonction exercée dans le club
Field is required!
Field is required!

Détails de justification de la candidature

Décrire les performances individuelle / performances club (Date, lieu, composition, résultat/rang, titre ...)
Performance individuelle / performance club
Field is required!
Field is required!
Dévouement
Field is required!
Field is required!

Prière de joindre à la candidature

- Les justificatifs (listes de résultats officiels attestant des performances réalisées)
- Les coordonnées complètes d'une personne de référence au club d'affiliation pouvant attester de la qualité des résultats obtenus.
Uploader vos documents ... (Champ obligatoire)
Champ obligatoire
Merci de joindre les documents demandés
Your Full Name
Field is required!
Field is required!

 

> La présente proposition est soumise à l’attention du Conseil intercommunal.
> Questionnaire à retourner au Centre Sportif Sous-Moulin d’ici au 10 janvier 2022.