You are on page 1of 1

ROSMA VOCATIONAL HIGH SCHOOL

Jl. Parahyangan RT. 03 RW. 03, Kel. Adiarsa Barat,


Kec. Karawang Barat Karawang

CLUB MEMBERSHIP APPLICATION

Full name : ______________________________________________________


Nick name : ______________________________________________________
Place, Date of birth : ______________________________________________________
Grade and Major : ______________________________________________________
Address : ______________________________________________________
______________________________________________________
______________________________________________________
Phone number : ______________________________________________________
Time : Thursday / Friday / Saturday * (choose one)
Your reason in joining English club _____________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________

DECLARATION

I, _____________________________ hereby declare that I will abide by the rules of the


English Club of Rosma Vocational High School.

Karawang, _________________
Signature of applicant

__________________________

Thank you for your attention, interest, and participation

For further information or if you have any question please do not hesitate to contact us.
Andhika Wijaya - 0821-1449-9016 Finna Puspita - 0857-1119-6490
Mr. Ganesha Agni - 0899-6922-502

You might also like