ࡱ>  )`bjbj.${{'52222222F 8* $N F#$n  " $Ghl!222 Hp2 2 22 b Tj r0#|2X#FF*. FF*. FFF222222 ZaBcznik do Regulaminu HYPERLINK "http://www.kartaseniora.wroclaw.pl/index.php?option=com_content&view=article&id=1:regulamin&catid=2:uncategorised&Itemid=104" wydawania iu|ytkowania  Aleksandrowskiej Karty Seniora przyjtego zarzdzeniem nr & & & Burmistrza Aleksandrowa Adzkiego z dnia & & .  WNIOSEK O PRZYJCIE DO PROGRAMU  ALEKSANDROWSKA KARTA SENIORA Prosz o przyjcie mnie w poczet uczestnikw programu  Aleksandrowska Karta Seniora . O[wiadczam, |e znane mi s postanowienia Regulaminu i zobowizuj si do ich przestrzegania. Jednocze[nie wyra|am zgod na przetwarzanie moich danych osobowych przez Urzd Miejski w Aleksandrowie Adzkim dla celw zwizanych z realizacj, promocj, monitoringiem i ewaluacj programu zgodnie z ustaw z dnia 29.08.1997r. o ochronie danych osobowych (Dz.U. z 2002r. nr 101 poz. 926 z pzn. zm.). 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Dowd osobisty: nr: & & & & & & & & & seria:& & & & & & wydany przez: & & & & & & & & & & & & & . Adres zameldowania: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & .. Adres do korespondencji: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . Numer telefonu: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & . Email: & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & & ..       ALEKSANDROWSKA KARTA SENIORA VZNRTXZ^`dfgd2 dgd4gd4gdzgd[LNPTVZ\`bfhjhc5B*CJaJphf hVhc5B*CJaJphfhcjhcUh jh UhQJhR2^J,1h. 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