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<A"TA SNNCY AO NAACTY

IIO: YrpaïHcuroï Craercuroï OpraHisaqiï - ilIACT - CraHøLli e

f u'R i npireuu¡e Ãuruu.Â:


ln¡eHa ra npisamula 6ATbKl B/On I KVH lB:

TeneSon: ( ) E-noura:
flara napogxeHHfl: Knnca e qoAeHHiü luroni:_ Knnca a u¡xo¡iyxpaitrosxaacrBa:

Bipoeuanannn: El Karo¡ør.lsre E flpaeocnaaHe E lHule -


MeÃr¿ qHi i nSoprvraqii (anepfii,rou¡o) :

ffi FULL NAME- irr¡'s inpisoøule A|4II4HV1 no anrniítcvt<u

address,/noBHa aApeca i qøcno Klarupt

citylMicueBicrr, state/creñr zip code-3øn


,.{

KoA

1. 3nap 3aranbHo i4erãni ocHoBr4 Ta BHxoBHi qini YrpaiHcbKoro flnacry ñ ,qap cBoþ 3roÃy Ha
BcrynneHHs Moro cnna/uoei,qoHbKt4 no VCO flnacr e 3CA.
2. 3narc, u4o nepeÃyMoBoro npuHanexnocrigo flnacry e 3HaHHq yxpaÏncuxoi ¡¡oeu. 3aRannrc, qo
Mofl,qnríHa 3Hae yrpaïncuxy MoBy ra Ãonoxy ecix rycnnu, u¡o6u eoxa iT nneKana ra BhBqana
yxpaïHosuaBcrBo.
3. 3narc, qo pefynnpHa yqacrb y npnnncar¡nx ¡aúr¡srrsx i ra6opax e ocHoBHr4M Br4xoBHr4lvr gaco6orrr
ra Aonoxy ecix aycnnu, 14o6 iHu¡i saüHsrrs ruoei ÃÄTvtHet 6ynø eignoeigno ycriüneni.
PiexoqacHo go6oe's3vrocfl noÃ6arn npo re, ¡4o6 rvriú cuu lMofl.qoHbKa:
tr 1. Xo,qile/-na go lUxonu yrpaïxosHaBcrBa.
tr 2. llpnxogne/-na roqr¡o na yci nnactosisaüHRrrs.
tr 3. flogepxyøaacnl-nacn flpaeun noeegiHrn a 4ouiaqi i ua ¡arlHnrrRx.
tr 4. llnarusl-na csoi .{neHcuxi BHecKu B npr,lnøcaHovry vaci e cyrvri $f5.
$65.
tr 5. flicras/-fla BnpoÄoBx Haù6nøxvoro uicRqr noeHøü nnacroeøü ogHocrpiñ
tr 6. Spae/-na yqacrb e nirHix nnacroBrlx ra6opax.
rex
caxl/-a crarØ q^eHon¡ MHKI4 EATbKIB, 6parø yvacru a ìT ginnuHocri ta to,rHo nnaruTr4
3 o6oa'nsyocs
qneHcuxr¡ø BHecoK, (ei¡noaiguo Ao r0ro Lril ff e ,{neH VCTIIyilC qø flnacrnpnrry), nK i raxox BqacHo
nonaroÄXyBarø yci QiHaHcosi so6oe's3aHHn cynporø craxuqi.

ïlpouy npuúHnmu ¡øo(toeo cuHa/ Moto ðoHbKy e qneHu YCO nnACT e 3CA.
f'lignrac 6arsxie a6o onixyr-rie

i.. Ogepxauo Kapry AHF:_ ñoprgxoee qhcno:


6
3asearh:
.' 1, ,"'
" Knc-3cÀ/0ctHb
yxpaïncurR cKABTcbKA oPrAH BruH UKRAINIAN SCOUTING ORGANIZATION

Ë^ ft/^fucr PLA;5r ä
E
,{ux
3aqna

Bcryuy B rrJreucrno Jlanrcu Earrrcin

Iu'a i upisnøqe

Irvr'x i upisnøqe(narurmorc

Aapeca (rarøurcorc)

9øc¡o rere(þony (

E-nor¡na

3assrsro ruoe 6axauHr BcryrrvtrvtB qnencrBo Jlaurø Eamris


ra so 6os'rsyro cr .qoroMar arþr B lp aqi cralrøqi/ryprraþox
Ta rrJrarnrø rvriü qJreucbKrrü sHecor (nrna¡ry) y nøcori $
sri¡uo 3 yxBaJroro 3ara¡ruøx 36opis JIaHrø EarrKis.

IIi¡nøc

IutR ¡uruHulalneit [ara


(ra upirnøqe, mrqo inarure si¡ 6amris) HapoÀrKeHHfl

KIIC-3CA 2002p.

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