do pobrania tutaj - WOPR-u
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do pobrania tutaj - WOPR-u
INTERNATIONAL LIFE SAVING FEDERATION Gemeenteplein 26, 3010 Leuven, Belgium. Tel +32/16-35.35.00 Fax +32/16-35.01.02 E-mail: [email protected] Web: http://www.ilsf.org REQUEST FORM FOR INTERNATIONAL CERTIFICATE FEDERATION: Please add 2 photographs to each request ·1 to be glued here ·1 for the identity card WODNE OCHOTNICZE POGOTOWIE RATUNKOWE The above mentioned Federation herewith confirms that the following individual has fulfilled all conditions set forward by ILS. Name: __________________________________________________ Forename: _______________________________________________ Date of birth: . . / . . / . . . . Place of birth: ____________________________________________ Language knowledge: ______________________________________ Address (street & n°): _______________________________________________________________ Zip + city: _________________________________________________________________________ Country: __________________________________________________________________________ Phone number: _____________________________________________________________________ e-mail: ____________________________________________________________________________ We request the following certificate(s): International Junior Lifesaver International Lifesaver (former FIS Lifesaver) International Pool Lifeguard International Inland Open Water Lifeguard International Surf Lifeguard International Lifesaver/Lifeguard Instructor (former FIS Moniteur) International Open Water Diver (*) International Rescue Diver (**) International Rescue Dive Master (***) International Rescue Dive Instructor (*) International Rescue Dive Instructor (**) International Rescue Dive Instructor (***) International Rescue Boat Driver Signature, Name and Function in the Federation Date Seal of Federation