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Formulir Pendaftaran Calon Penegak Ambalan

SMKN 58 Jakarta

Nama lengkap : .........................................................................

Tempat&tanggal lahir : .........................................................................

Agama : .........................................................................

Jenis kelamin : .........................................................................

Nama orang tua/wali : .........................................................................

Pekerjaan Orang tua : .........................................................................

Alamat : .........................................................................

Anak Ke : ..........................................................................

Gol. Darah : ..........................................................................

Sekolah : ..........................................................................

Hobby dan Bakat : ..........................................................................

Alasan : ..........................................................................

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Tanda tangan peseta,


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