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PANITIA PELATIHAN KEPEMIMPINAN DASAR

PIMPINAN ANAK CABANG GERAKAN PEMUDA ANSOR


KECAMATAN KLAKAH KABUPATEN LUMAJANG
Sekretariat: Gedung MWC NU Klakah, Jl. Raya Klakah – Probolinggo Telp 085230234560 Kodepos 67356

FORMULIR PENDAFTARAN PESERTA


PELATIHAN KEPEMIMPINAN DASAR
PAC GP ANSOR KECAMATAN KLAKAH
TAHUN 2020

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Tempat, Tanggal Lahir : .................................................................................................................

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NIK : .................................................................................................................

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Pendidikan Terakhir : .................................................................................................................

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

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No. Telp : .................................................................................................................

E-Mail : .................................................................................................................

Utusan dari : .................................................................................................................

Tujuan untuk mengabdi di Gerakan Pemuda Ansor :

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Lumajang, ............................ 2020


Calon Peserta,

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