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SMADA MUSLIM COMPETITION 2013

SMA Negeri 2 Surabaya Jalan Wijaya Kusuma 48 Surabaya-Jawa Timur,


Tlp. (031) 5345972 , Fax. 5468564,
Blog: www.smcsmada2013.blogspot.com Email :
Smc_smada@yahoo.com
Twitter : @smc_smada

Formulir Pendaftaran Lomba Cerdas Cermat Islami

Nama

Lengkap Peserta :

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2. ............................................................
Tempat Tanggal Lahir :
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2. ...........................................................
No. Telepon/Hp

1. ...........................................................
2. ...........................................................
Email

1. ..........................................................
2. ..........................................................
Asal Sekolah : .............................................................
Alamat Sekolah

: .............................................................

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Telp/Fax Sekolah : Telp: ................................,
Fax: ........................................
*formulir untuk 1 kelompok yang berjumlah 2 orang

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