CABOR :
AGAMA :.............................................................................
No. HP :...........................................................................................
2. NAMA ORANGTUA/WALI :.............................................................................
PEKERJAAN ORANGTUA :.............................................................................
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Keterangan:
1. Peserta bukan juara POPNAS atau KEJURNAS
2. Peserta Bukan Binaan Pusat Pendidikan Dan Latihan Olahraga Pelajar (PPLP)
atau Sekolah Khusus Olahragawan (SKO)
NO URUT: KAB/KOTA :
CAB. SENI :
AGAMA :.............................................................................
No. HP :...........................................................................................
2. NAMA ORANGTUA/WALI :.............................................................................
PEKERJAAN ORANGTUA :.............................................................................
………………………………