Anda di halaman 1dari 1

PANITIA

EXPO KKN LOKASI II B KECAMATAN KRAMAT


UNIVERSITAS NEGERI SEMARANG
BERPANGKALAN PADA KANTOR KECAMATAN KRAMAT,
KABUPATEN TEGAL
Jalan Garuda 1 Kemantran, Kramat CP : (085726367589)

FORMULIR PENDAFTARAN
LOMBA MEWARNAI

Nama Peserta : .........................................................................................................

..........................................................................................................

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

..........................................................................................................

Asal Sekolah : .........................................................................................................

Desa/Kelurahan : .........................................................................................................

No Telepon : .........................................................................................................

Kramat, November 2017

Hormat Kami,
Mengetahui,
Camat Kramat Ketua Panitia

Wuryanto, S.Sos Ismail Supriyatno Putro


NIP. 19720925 199103 100

Anda mungkin juga menyukai