
                                   P  I H L   K A
            na porn sout a prohlen o zdravotnm stavu soutcch. 
                 Doruit poadateli nejpozdji v den konnm soute

Organizace: ........................................................................

Datum a msto konn: 29.z 2001 Vesel nad Lunic
Kategorie: Mui   eny     (nehodc se krtnte)
Druh soute: 2. ronk memorilu Josefa ahoura

Prohlauji, e nemm dn zdravotn pote, kter by m brnily ve startu na shora 
uveden souti

Pjmen a jmno                    Rodn slo             Podpis

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V .......................... dne .............  Raztko a podpis zstupce organizace:



