PADUAN SUARA PEMUDA ETERNITY CHOIR

DINAS KEBUDAYAAN DAN PARIWISATA SUMATERA SELATAN

Jl. Demang Lebar Daun Kav. IX Palembang, Sumatera Selatan

FORMULIR PENDAFTARAN
NO. REGISTRASI

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NAMA

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TEMPAT/TANGGAL LAHIR

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

ALAMAT

: .....................................................................................
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NO. TELP/HP

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

PENDIDIKAN TERAKHIR

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PEKERJAAN

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PENGALAMAN ORGANISASI : 1...................................................................................

(JABATAN)
2...................................................................................
3...................................................................................
PRESTASI

: 1..................................................................................

(DALAM SENI SUARA/MUSIK)

2...................................................................................
3...................................................................................
ALAT MUSIK YANG DIKUASAI : ............................................................................................

PERNAH TERGABUNG DALAM PADUAN SUARA? YA / TIDAK

JIKA YA, NAMA PADUAN SUARA : ..............................................................................
PALEMBANG,

JUNI 2016

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