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FORMULIR PENDAFTARAN

No. Pendaftaran : ........................................................................................................


Nama : ........................................................................................................
NIM : ........................................................................................................
Jurusan : ........................................................................................................
Tempat & Tanggal Lahir : ........................................................................................................
Alamat Asal : ........................................................................................................
Alamat di Yogyakarta : ........................................................................................................
No. Telp (Hp) : ........................................................................................................

Syarat –syarat Pendaftaran :


1. Membayar uang pendaftaran Rp. 20.000,-
(sudah termasuk buku Rapor dan Iuran bulan pertama).
2. Menyerahkan pas foto 3x4 = 2 lembar (berwarna).

Yogyakarta,…………….…………...2008
Anggot Baru

(……………………...........……….….)

Pas foto 3x4

No. Pendaftaran : ........................................................................................................


Nama : ........................................................................................................
NIM : ........................................................................................................
Yogyakarta,…………….…………...2008
Pengurus

(……………………...........……….….)

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