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Inschrijfformulier

W.S.V. WANDELVREUGD AVOND4DAAGSE 2017. medaile/
DEELNEMERS(GROEP)   TOTAAL AFSTAND nummer:
NAAM: voor en   achternaam   BEDRAG 2,5-5-10km 1e-2e-etc.  
 ______________________________ ________x €________ __________  _________   
 ______________________________ ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________ ________x €________ __________ _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________  ________x €________ __________  _________   
 ______________________________ ________x €________ __________  _________   
TOTAAL:                     x