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ae Der ear) Prey RAC * YAK 616,32/33(083.13) BBK 54.13 Kg Kneucveexue pexauendauuy paspabomans u perosendoaanes Poccuiicxoit cacmpouneprocunecxvre accounts 1 Aeconuauue eduyunerts aqecmne no Kaeen Pexowenayeren Yuebno-neroanveckit oGie-UNeHHEN Ho MesINEKOMN st hIp= MaucoTINIcekoMy obparoBAHO HyIOR PoceH H KatleCTHE YHeOHOTE MOCOGNNE ALI HcteM NOEeAYIOHEKOO MpAXHeCCHOHAAHO!O OBpKARONIHT NPAT K49 Kununeexne pekowersianan, Pueypoourepasorist stot pet BT. Misi kuna, ~ M.: T3OTAP-Meaua, 2008. ~ 208 € ISBN 978-5-9704.0796.7 Voaanine coxepant KannIFieckie peKOMeHAUI HO HANBoIeE pactipo- eTpaHEHNLIM raeTpOsHTEPOLONICKIM IAGOAEHANIHIN, HOAPOTOBIEHKEE 4H pexoverttonamnbie Poceititekoit retpoyerepotorysieckoHt accoumratLte KoMnutieexite pekoMeHLiauMiY RKNOTOT JelfcrasIL wpa Mo aMarMOcTHKE neacinne, nporbiLtaKTiKe 1 peasietraun, B eGopiitk BOUL OSU H1aC~ "iiie Honpocts FerpeDHTepO7Or. 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HayK, aouent Kaeaper Aponenerriakis wiryrpennitx Gone sNelt MMA sot. H.M. Ceyenona Cexsoiea Mapua Hropentia, Kant. sea, stay, acenereHT Kalbeapal sponeacet Kt uyTpeNAX BoxesHelt MMA iw, H.M, Cesenona Tpyxmanos Anckeaap Cepreeswy, xaivt. wea. Hayk, aoueHnT Kary Iiporteaesrinkit BHYTpEHHNY Goute melt MMA ust, HM. Cevenona pou a Xasauon Avexcanap Hapanaenuy, aoxr. wea. uayx, mpod. Katbeapm raerpoontepororiu Tocyaapetelioro MNcTieTyTa YeoRepulcHeTROnait spaveit Mivinerepersa oGopontt Po Ulenryanu Apkaanit Aaexeauaposity, aokt. sted, Hayk, Mipomp. Kaeapur HpOneaceTuKH BHYTPEHHMN GouewHelt MMA iM, HM, Cesenona Wapokora Exevia Hukosaenia, Karts. we. Hayk, LIeHT Kkadhenpor Hponteaewrtkit nyrpenitx Goxeaeit MMA ust. H.M. Ceieriona Haysnbie penaxropet Gayyaxanon Pycram AGGacom owen Karbeapls FocnurraNHott ‘reparnun Kaaaiiekoro rocyaapeTnenHoro MeaMuMHekOro yHKnepesTera Byenepon Anexcell Oaerom, Kalid, Med. Hak, JOMeHT Kalbeapst NponlexeBrAKit uyrpentinx Goaeaneli MMA ust, HM. 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Bostinkaior npit nepenoanenitn ninutenosa m HeHesaior Hocae pe- TYPHHTALMH ILIKE MPOXOACHUS. MHULE B 2e-TYAOK. Cpoirnpante (peryprirattia)® sanepxnnaiouelicn p nuutenose niuelt iutit caitabio, TIpi HesHasutrenbHOM pacumpenmn mtuIeBOLA cpEirH- BaHHE BOSHHKACT NOGIE HecKOABKHX roTKoR. Tp aHaNHTeMbHOT AWA TALIM THMLeHO-TA PeryPLHTTALLHST BOSHUKAET Pex, OAHAKO OOBITHO odnéM perypriTHpyemoit MHL Gonine. CoxepAHMOC MuULeROAA LPH epbirnnatint MoxeT nonasaTe w abIXeTeABHDIE MYTH Tloxyaanite® Tanittio, tacto xapakteprayer TaxeCTb TeHeKHs GostesH, Tloreps maces Tera vacro socturaer 10, 20 Kr it Gost. 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