FORMULIR PENDAFTARAN

No. Pendaftaran

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

Nama

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

NIM

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

Jurusan

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

Tempat & Tanggal Lahir...................................................................................:
.....................................................................................
Alamat Asal

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

Alamat di Yogyakarta : ..................................................................................
No. Telp (Hp)

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

Syarat –syarat Pendaftaran :
1.

Membayar uang pendaftaran Rp. 20.000,(sudah termasuk buku Rapor dan Iuran bulan pertama).

2. Menyerahkan pas foto 3x4 = 2 lembar (berwarna).
Yogyakarta,…………….
…………...2008
Anggot Baru

(……………………...........……….
….)
Pas foto 3x4

No. Pendaftaran

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

Nama

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

NIM

: ..................................................................................
Yogyakarta,…………….
…………...2008
Pengurus

...) .......……….(……………………. …..

Sign up to vote on this title
UsefulNot useful