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FUTSAL Referee Course Application Form

FUTSAL Referee Course Application Form

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Published by Ann Moey

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Published by: Ann Moey on Jul 02, 2012
Copyright:Attribution Non-commercial

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07/02/2012

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FIFA Training, Ban HouayHong, Chanthabouly District, Vientiane Capital, P.O.Box 1800Tel: +856-20-560821, 562620, Fax: +856-20-560820, Email: contact@laoff.org
ສາ຋າລະຌະລັຈ
 
ຎະຆາ຋ິຎະແຉ
 
ຎະຆາຆ຺ຌລາວ
 
ສັຌຉິຑາຍ
 
ຽຬກະລາຈ
 
ຎະຆາ຋ິຎະແຉ
 
ຽຬກະຑາຍ
 
ວັຈ຋ະຌະຊາວຬຌ
 ********000********
ກະຆວຄສຶກສາ຋ິກາຌ
 
຾ລະ
 
ກິລາ
 
ສະຫະຑັຌຍາຌຽຉະ຾ຫ່ຄຆາຈລາວ
 
ຌະ຃ຬຌຫົວຄວຼຄ຅ັຌ
,
ວັຌ຋ີ……/…../2012
 
຾ຍຍຒຬຓສະໝັກຽຂ຺້າຐຶກຬ຺ຍອ຺ຓກຳຓະກາຌຉັຈສິຌ
 
ຒຸຉຆຬລ
 
ຆື່
 
຾ລະ
 
ຌາຓສະກຸຌ:……………………………………຋ີ່ດູ່ຎະ຅ຸຍັຌ
 
ຍ້າຌ:………………………ຽຓືຬຄ:……………………………຾ຂວຄ:…………………………………………………………...
 
ຽຍີ຿຋ຉິຈຉໍ່:………………………………ຬີຽຓວ:……………………………………………………
 
຾ຍຍຒຬຓສະຍັຍຌີ້຾ຓ່ຌເຆ້ຽຑື່ຬອັຍສະໝັກສຳຓະຌາກຬຌ຋ີ່຅ະຽຂ຺້າຓາຐຶກຬ຺ຍອ຺ຓກຳຓະກາຌຉັຈສິຌ
 
ຒຸຉຆຬລ
 
ລະຈັຍຂັ້ຌຑື້ຌຊາຌ
,
ຽຆິ່ຄ຅ະ຅ັຈຂຶ້ຌ຋ີ່
 
ສະຫະຑັຌຍາຌຽຉະ຾ຫ່ຄຆາຈລາວ
 
ເຌລະຫວ່າຄວັຌ຋ີ
:
………/……/
 
ຽຊິຄ
 
ວັຌ຋ີ:……../……/2012.
 
ໝາງຽຫຈ
:
ຽລີ້ຓຽຎີຈອັຍສະຓັກ຾ຉ່ວັຌ຋ີ:……./…../ຫາວັຌ຋ີ:…….
/
……/2012 ຾ລະ຅ະຽລີ່ຓຽຎີຈຍັ້ຌຐຶກຬ຺ຍອ຺ຓເຌວັຌ຋ີ:……/…../2012, ຑາກຽຆ຺້າຉັ້ຄ຾ຉ່ຽວລາ
09:00
11:30
຾ລະ
 
ຑາກ຾ລຄຉັ້ຄ຾ຉ່ຽວລາ
13:30
16:30.
ຏູ້ສະໝັກ
 
 
FIFA Training, Ban HouayHong, Chanthabouly District, Vientiane Capital, P.O.Box 1800Tel: +856-20-560821, 562620, Fax: +856-20-560820, Email: contact@laoff.org
ສາ຋າລະຌະລັຈ
 
ຎະຆາ຋ິຎະແຉ
 
ຎະຆາຆ຺ຌລາວ
 
ສັຌຉິຑາຍ
 
ຽຬກະລາຈ
 
ຎະຆາ຋ິຎະແຉ
 
ຽຬກະຑາຍ
 
ວັຈ຋ະຌະຊາວຬຌ
 ********000********
ກະຆວຄສຶກສາ຋ະກາຌ
 
຾ລະ
 
ກິລາ
 
ສະຫະຑັຌຍາຌຽຉະ຾ຫ່ຄຆາຈລາວ
 
ຌະ຃ຬຌຫົວຄວຼຄ຅ັຌ
,
ວັຌ຋ີ……/…../2012
 
ເຍຆີວະຎະຫວັຈ
 
ຂຬຄຌັກສຳຓະຌາກຬຌ຋ີ່຅ະຽຂ຺້າຐຶກຬ຺ຍອ຺ຓ
 
ຒຸຉຆຬລ
 
1.
 
ຆື່
 
຾ລະ
 
ຌາຓສະກຸຌ:………………………………………….. ວັຌ
,
ຽຈືຬຌ
,
ຎີຽກີຈ:……………
 2.
 
ສັຌຆາຈ:………. ຆ຺ຌຽຏ຺່າ:………… ສາຈສະໜາ:……… ລວຄສູຄ: ………….ຌ້ຳໜັກ:……….
 3.
 
ຍ້າຌຽກີຈ:…………………….. ຽຓືຬຄ:……………..……..຾ຂວຄ:………………..…………..
 
ຎະ຅ຸຍັຌດູ່ຍ້າຌ:………………..ຽຓືຬຄ:…………………….. ຾ຂວຄ:…………………………..຿຋ລະສັຍຍ້າຌ:…………………. ຿຋ລະສັຍຫ້ຬຄກາຌ:………………… ຓືຊື:………………….
 4.
 
ຬາຆີຍຎະ຅ຸຍັຌ:………………………………. ສະຊາຌ຋ີ່ຽອັຈວຼກ:……………………………...
 5.
 
ລະຈັຍກາຌສຶກສາ
(
຅຺ຍ
) :
ຎະຊ຺ຓ
,
ຓັຈ຋ະງ຺ຓຉ຺້ຌ
,
ຓັຈ຋ະງ຺ຓຎາງ
.6.
 
ລະຈັຍວິຆາສະຽຑາະ
(
຅຺ຍ) :……………. ຆັຌຉ຺້ຌ
,
ຆັ້ຌກາຄ
,
ຆັ້ຌສູຄຂຶ້ຌແຎ
.7.
 
ລະຈັຍຑາສາຉ່າຄຎະຽ຋ຈ:……………….. ຉໍ່າ
,
ຑໍເຆ້
,
ຈີ
 8.
 
ແຈ້ອັຍກາຌຐຶກຬ຺ຍອ຺ຓກຳຓະກາຌຉັຈສິຌ
 
ຒຸຉຆຬລ
 
຅ັກ຃ັ້ຄ:…………………………………………
 9.
 
ຽ຃ີງແຈ້ຉັຈສິຌ
 
ຒຸຉຆຬລ
 
ລະຈັຍ
:
ກ…………ຂ…………຃……………………………………຾ຉ່ຎີ:……………………..ຫາຎີ:………………………………..
 10.
 
ຽ຃ີງຽຎັຌຑະງາຈຎະ຅ຳຉ຺ວ:…………………………………………………………………..
 
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