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FORMULIR

PELAKSANAAN KEGIATAN PRAMUKA


GUGUS DEPAN 12.119-12.120
MI ANSORIYAH

I. Umum
Gugus Depan : 12.119-12.120
Pangkalan : MI ANSORIYAH
Alamat : Kp. Cireundeu Desa Ciroyom Kec. Bojonggamir Kab.
Tasikmalaya
II. Kegiatan :
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III. Waktu dan Tempat :
Hari / tanggal : ......................................................................................................
Pukul : .................................. WIB s.d. ..................................... WIB
Tempat : ......................................................................................................
IV. Biaya :
Kas : Rp. ...............................................................................................
Sumbangan Anggota : Rp. ...............................................................................................
Sumbangan Pihak Lain : Rp. ...............................................................................................
Jumlah : Rp. ...............................................................................................
V. Alat / Perlengkapan yang dipergunakan :
.......................................................................................................................................................
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.......................................................................................................................................................
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VI. Kekuatan Jumlah Peserta yang hadir : VII. Lain – lain :
Regu Jumlah
………………………………………………
Tidak
Hadir
hadir
………………………………………………
Regu 1 pa
Regu 2 pa ………………………………………………
Regu 3 pa
………………………………………………

Regu 1 pi ………………………………………………
Regu 2 pi
Regu 3 pi ………………………………………………

………………………………………………

Pembina Pi, Pembina Pa,

(………………………………..) (………………………………..)

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