ࡱ> M $ bjbj== #WW$l&xNdddd}$v ; ddy; ; ;  dd}; }; ; :,YdB ^ Y$0R@Y;  EMBED PBrush Consultrio Veterinrio Thaity Ellen Ficha de Inscrio para o clubinhoPreencha corretamente os campos abaixo. Com os dados fornecidos nesta ficha, ser gerado o contrato de afiliao do co ao clubinho do Consultrio Veterinrio Thaity Ellen. Aps o preenchimento da ficha, ela dever ser entregue no consultrio. Dados do Proprietrio Nome: ___________________________________________________________________________ Endereo completo: _______________________________________________________________ Telefones para contato: ( __ ) _______________ - Residencial ( __ ) _______________ - Comercial ( __ ) _______________ - Celular Nmero da carteira de identidade (RG): ______________________ Dados do Animal Nome: ___________________________________________________________________________ Raa: ____________________________________________________________________________ Data de Nascimento (aproximada): ___ \ ___ \ ___ (caso no saiba, estime uma data) Vencimento da prxima vacinao: ___ \ ___ \ ___ (Veja na carteirinha de vacinao) Preferncias para o clubinho Dia da semana para o clubinho: ______________ (escolher um dia entre segunda e sexta feira) Horrio para o clubinho no dia escolhido acima: ___ : ___ (escolher horrio entre 9:00 e 17:00) Dia do ms para o pagamento da mensalidade: _____ (preencher com o dia do ms de sua preferncia) Incluir opcional de consulta veterinria: ____ (responder sim ou no) 9\]RSTj): [ m  ʶޢkUkUkU=U=U=U.0J5>*B*CJOJQJ\aJmHphsH+0J5B*CJOJQJ\aJmHphsH+0J5B*CJOJQJ\aJmHphsH#0J6B*OJQJ]mHphsH0JB*OJQJmHphsH'0J5B*CJOJQJ\mHphsH'0J6B*CJOJQJ]mHphsH'0J6B*CJ$OJQJ]mHphsH'0J6B*CJ OJQJ]mHphsHjR1C UV jU9\] Tjz/$$d%d&d'd-D M NOPQa$<<[$\$D$$Ifl05 $ 64 la $$Ifa$$ jkO)*:;53$ $d%d&d'd-D M NOPQa$.h<<$d%d&d'dNOPQ[$\$^h56 o p # $ /$$d%d&d'd-D M NOPQa$.h<<$d%d&d'dNOPQ[$\$^h  ! $ +0J5B*CJOJQJ\aJmHphsH.0J5>*B*CJOJQJ\aJmHphsH,1h/R / =!"#$%F Y{DOqdwM'JFIF``C    $.' 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