PASKIBRA SEKOLAH

SMAN 2 TAMBUN UTARA

Sekretariat: Perumahan Alamanda Regency Blok F Desa Karang Satria

Tambun Utara-Kabupaten Bekasi. No.Telp: 021-88375893 Email: Kopastra@yahoo.com

FORMULIR PENDAFTARAN
NAMA SEKOLAH : ..................................................................................................................................................
ALAMAT SEKOLAH : ..................................................................................................................................................
....................................................................................................................................................
NO. TELP SEKOLAH : ..................................................................................................................................................
PEMBINA/PELATIH : ..................................................................................................................................................
NO. TELP : ..................................................................................................................................................

Danton
5 4 3 2 1

Cadangan
10 9 8 7 6 1

Cadangan
15 14 13 12 11 2

Danton : ....................................................
Pasukan Inti :
1. ........................................... Ket. Ukuran foto 2x3
2. ........................................... 9. .........................................
3. ........................................... 10. .........................................
4. ........................................... 11. .........................................
5. ........................................... 12. .........................................
6. ........................................... 13. .........................................
7. ........................................... 14. ......................................... Mengetahui,
8. ........................................... 15. .......................................... Kepala Sekolah
Cadangan :
1. ..........................................
2. .......................................... (.................................................)