ANEXO I

FICHA DE INSCRIÇÃO - PRÊMIO “ZUMBI DOS PALMARES” - EDIÇÃO 2023

1. Categoria Cultural

- Indicação: _______________________________________________________

- Breve Justificativa da Indicação:______________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________

2. Categoria Esporte

- Indicação: _______________________________________________________

- Breve Justificativa da Indicação:______________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________ _________________________________________________________________

3. Categoria Saúde

- Indicação: _______________________________________________________

- Breve Justificativa da Indicação:______________________________________ ______________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

4. Categoria Educação

- Indicação: _______________________________________________________

- Breve Justificativa da Indicação:______________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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5. Categoria Cidadania

- Indicação: _______________________________________________________

- Breve Justificativa da Indicação:______________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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6. Categoria Personalidade 2022

- Indicação: _______________________________________________________

- Breve Justificativa da Indicação:______________________________________ _____________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________________

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