SpaceScoopnatjeaj

Kontaktniobrazac

MolimVasdaispuniteobrazacipoaljetegazajednosradomza
natjecanjeelektronikompotomnaadresu:
danijela.takac@gmail.com
ilipotomna:

OPantovak(zanatjeajSPACESCOOP)
Hercegovaka108
10000Zagreb,Hrvatska

Imeiprezime:_______________________________________________

Godine:_______________

Spol:_______________

Jezik:_______________

Emailadresa:____________________________________________________

Adresa:____________________________________________________

_________________________________________________________________

_________________________________________________________________

Potanskibroj:_______________

IzabranapriaSpaceScoop(nasloviliURLadresa):

_________________________________________________________________

RecitenamzatosteizabralibaovuSpaceScooppriu:

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

_________________________________________________________________

Potvrujemdajeraduprivitkuoriginalidagajeizradio/lagorenaveden/auenik/ca
(Molimoisprintajteipotpiite):

_________________________________________________________________

_________________________________________________________________

Potpisuitelja/skrbnika/roditelja:

_________________________________________________________________

Datum:

_________________________________________________________________