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FORMULIR PENDAFTARAN

BIMBEL PADI SMART COLLEGE


Homepage : www.padismartcollege.com Email : admin@padismartcolelge.com
Phone : 02194437266/02133443248 Mobile : 081284568591
No. Induk Siswa :

Nama Lengkap

: ___________________________________________________________

TTL

: ___________________________________________________________

Jenis Kelamin

: ___________________________________________________________

Agama

: ___________________________________________________________

Alamat Lengkap

: ___________________________________________________________

No. Telpon Rumah

: __________________________/________________________________

Handphone

: __________________________/________________________________

Email

: __________________ _Facebook username : ______________________

Nama Orang Tua/ Wali

: ___________________________________________________________

Alamat Orang Tua

: ___________________________________________________________

Handphone

: ___________________________________________________________

Asal Sekolah

: ___________________________________________________________

Kelas

: ___________________________________________________________

Alumni Angkatan

: ___________________________________________________________

Hobi

: ___________________________________________________________

Perguruan Tinggi diminati

: __________________________________________________________

Hari dan waktu dipilih

: __________________________ Pukul ___________________________

Catatan Siswa

: __________________________________________________________

Bekasi,
Pendaftar,

(
)

2011
Admin Padi

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