Anexa 2

FIŞĂ DE ÎNSCRIERE
Numele echipei:
_______________________________________________________________
Persoană de contact:
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E-mail: _________________________________________________________________
Telefon: ________________________________________________________________
Membrii echipei:
1.

Nume: ______________________________________________________

Premune: ___________________________________________________
Anul de studiu: _______________________________________________
Instituţia de învăţământ: ________________________________________
2.

Nume: ______________________________________________________

Premune: ___________________________________________________
Anul de studiu: _______________________________________________
Instituţia de învăţământ: ________________________________________
3.

Nume: _____________________________________________________

Premune: ___________________________________________________
Anul de studiu: _______________________________________________
Instituţia de învăţământ: ________________________________________
Coordonator echipă:
Nume: ____________________________________________________________
Prenume: _________________________________________________________
Funcţia: __________________________________________________________
Data: