FICHA DE FILIAÇÃO DAS ASSOCIAÇÕES DOS AGENTES DE ENDEMIAS DO ESTADO DO CEARÁ
MUNICIPIO_______________________ NOME DA ENTIDADE:___________________________________________________________
ENDEREÇO:____________________________________ N.º____________________
BAIRRO:______________________________CIDADE:________________ESTADO:___ CNPJ N.º_________________________
DATA DE FUNDAÇÃO:_____/ _____/______ CONTATOS:_____________________________________________________________
NUMERO DE MEMBROS: N.°___________________ NOME DOS DIRETORES:
PRESIDENTE: _______________________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
VICE - PRESIDENTE: ________________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
1.º (ª) SECRETARIO(A):_____________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
2.º (ª) SECRETARIO(A):_____________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
1.º (ª) TESOUREIRO(A):_____________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
2.º (ª) TESOUREIRO(A):_____________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
1.º(ª) MEMBRO (A) TITULAR:_________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
2.º(ª) MEMBRO (A) TITULAR:________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
3.º(ª) MEMBRO (A) TITULAR:__________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
1.º(ª) MEMBRO (A) SUPLENTE:________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
2.º(ª) MEMBRO (A) SUPLENTE:________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
3.º(ª) MEMBRO (A) SUPLENTE:________________________________________________________________________________
RG:_______________________________________________ CPF: ____________________________________________________
ENDEREÇO:__________________________________________________________________ N.º___________________________
BAIRRO: ____________________________________________________________________________________________________
CIDADE:_____________________________ESTADO:___________________CONTATOS: FONE_____________________________
CEL: ________________________________ EMAIL: _________________________________________________________________
