FORMULIR PENDAFTARAN

KABAH GABUNGAN HIMA-HIMI PERSIS SE-BANDUNG RAYA

@ STAPI CIGANITRI
24-26 DESEMBER 2010

Nama : ..................................................................................
TTL : ..................................................................................
Alamat : ..................................................................................
Asal Sekolah : ..................................................................................
Jurusan/UniV : ..................................................................................
No Kontak : ..................................................................................
Riwayat Pendidikan :
TK                               : ...............................Th…....……..Th…………..
SD                               : ...............................Th…....……..Th…………..
SMP/Tsanawiyyah      : ...............................Th…....……..Th…………..
SMA/MA/Mu’allimin : ...............................Th…....……..Th…………..
Riwayat Organisasi:
1.    ..................................................................................................................................
2.    ..................................................................................................................................
3.    ..................................................................................................................................
4.    ..................................................................................................................................
5.    ..................................................................................................................................
Alasan Mengikuti KABAH :
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................
...........................................................................................................................................

…….., ……………….

                 ttd

(..........................................)