MEMBRESIA

ORGANIZACIN CULTURAL SKALD

FOTO

PERSONAL
NOMBRES
Y
APELLIDOS:
______________________________________________________________________________________________
____
DOCUMENTO IDENTIDAD: _____________________________ DE: _____________________________ R.H.:
__________________________
FECHA
Y
LUGAR
DE
NACIMIENTO:
______________________________________________________________________________________
DIRECCIN: _______________________________________________
ESTRATO: __________________
TEL:
__________________________
CEL:
________________________________________________

BARRIO:_______________________

_____________________________

E-MAIL:

PERMISO DE CONDUCIR: _____________________ E.P.S.: ____________________________ NUCLEO

FAMILIAR: ________________
______________________________________________________________________________________________
_________________________________

ACADEMIA
SECUNDARIA:
INSTITUCION:
______________________________________________________________________________________________
________________
FECHA INICIO: _________________________________ CURSOS: ________________________________
IDIOMA(S): ___________________
______________________________________________________________________________________________
_________________________________
DEPORTE(S):
______________________________________________________________________________________________
_________________

UNIVERSIDAD:
INSTITUCION:
______________________________________________________________________________________________
________________
CARRERA: _____________________________________________________________ FECHA INICIO:
___________________________________
SEMESTRES:_________________
OTROS
________________________________________________________________________

ESTUDIOS:

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________________________________
IDIOMA(S):
______________________________________________________________________________________________
__________________
DEPORTE(S):
______________________________________________________________________________________________
_________________

LABORAL
NOMBRE
EMPRESA:
______________________________________________________________________________________________
_________
CARGO: ____________________________________ FECHA
TIPO: __________________________

INICIO:

_____________________________

FECHA
Y
LUGAR
DE
NACIMIENTO:
______________________________________________________________________________________
DIRECCIN: _______________________________________________
BARRIO:_______________________TEL: __________________________

HUMANIDADES
HABILIDADES:
____________
CULES:
______________________________________________________________________________________
ASPIRACIONES:
______________________________________________________________________________________________
______________
CURSOS
/
DIPLOMADOS
/
TALLERES:___________________________________________________________________________________
______________________________________________________________________________________________
_________________________________
PRCTICA
RELIGIOSA:
______________________________________________________________________________________________
______
PAISES
QUE
HA
VISITADO:
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_

SKALD
FECHA
INGRESO:
__________________________________________
EDUCATIVO:_________________________________________

NIVEL

PSEUDNIMO:
______________________________________________________________________________________________
_______________
STATUS:
_____________________________
FAMILIAR:_______________________

EXPERIENCIA:

REPUTACIN:
_______________________
GREMIO(S):______________________________

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CONDICIN:

CASA

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TITULO(S):
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___________________
______________________________________________________________________________________________
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OFICIO(S):
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FIRMA MIEMBRO
DIRECTOR

FIRMA