Form Pendaftaran Debat

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FORMULIR PENDAFTARAN

DEBAT KEPEMUDAAN SE-JATIM 2016

NAMA SEKOLAH : ……………………………...………………………………………………….

NAMA PENDAMPING : ………………………………........……………………………………………
NAMA PESERTA
Nama Ketua : …………………………………………………………….
Foto
3x4 NIS : …………………………………………………………….
Tempat, Tgl Lahir : …………………………………………………………….
Alamat : …………………………………………………………….
Nomor HP : …………………………………………………………….
Email : …………………………………………………………….

Nama Anggota I : …………………………………………………………….

Foto
3x4 NIS : …………………………………………………………….
Tempat, Tgl Lahir : …………………………………………………………….
Alamat : …………………………………………………………….
Nomor HP : …………………………………………………………….
Email : …………………………………………………………….

Nama Anggota II : …………………………………………………………….

…………………………….., ……………………….. 2016

Hormat kami,
Ketua Tim,
(…………………………………….)

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