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Formulir Guk Yuk

Formulir Guk Yuk

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Dipublikasikan oleh ramarimar

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Published by: ramarimar on Nov 22, 2011
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05/22/2013

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PANITIA PEMILIHAN

GUK DAN YUK SIDOARJO 2011
Sekretariat :
Kom!ek Sta"io# GELORA DELTA
Pi#t$ Tim$r %&' No( 2)A SIDOARJO Te!( *0+1, -- 10. //1
0ORMULIR PENDA0TARAN PESERTA
PEMILIHAN GUK DAN YUK SIDOARJO 2011
DATA PRIBADI
1. Nama Lengkap : ...................................................................................................................
2. Tempat Tanggal Lahir : ...................................................................................................................
3. Usia : ...................................................................................................................
4. Jenis elamin : ...................................................................................................................
!. Alamat " N#. Telp : ...................................................................................................................
$. Pen%i%ikan : ...................................................................................................................
&. Asal 'ek#lah " Uni(ersitas..................................................................................................................:
). Tinggi " Berat Ba%an : ...................................................................................................................
*. +inat %an Bakat : ...................................................................................................................
1,. Pengalaman -rganisasi.: ...................................................................................................................
11. Prestasi. : 1.................................................................................................................
2.................................................................................................................
3.................................................................................................................
'i%#ar/#0.....................................2,11
-rang T1a Panitia
2...........................................................3 2.........................................................3
.4isa %ian/1tkan %i 4elakang

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