Nama : ........................................................................................................
Agama : ........................................................................................................
Nomor HP / WA : ........................................................................................................
Pekerjaan : ........................................................................................................
Alamat : ........................................................................................................
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Menyatakan bahwa siap mengikuti Pelatihan ToT (Training of Trainer) untuk Program
Gerakan Patriot Desa (GPD).
Demikian surat pernyataan ini saya buat atas kehendak sendiri dan untuk
dipergunakan sebagaimana mestinya.
Hormat Saya,
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