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GERAKAN PRAMUKA

MIS AT-TAQWA RANCAEKEK


KWARTIR RANTING RANCAEKEK KWARCAB BANDUNG
Kp. Jelegong RT.06 RW.05 Ds. Sukamulya Kec. Rancaekek Kab. Bandung

FORMULIR PENDAFTARAN ANGGOTA GERAKAN PRAMUKA

1. Nama Lengkap : ............................................................................................................


2. Tempat dan Tanggal Lahir : ............................................................................................................
3. Agama : ............................................................................................................
4. Nama Orang Tua/Wali : ............................................................................................................
5. Pekerjaan Orang Tua/Wali : ............................................................................................................
6. Alamat Rumah : ............................................................................................................
7. Anak ke : .... Jumlah saudara : Pa .... Pi .... orang
8. Golongan Darah : ............................................................................................................
9. Sekolah : ............................................................................................................
10. Bakat dan Hobby : ............................................................................................................
11. Hal – hal yang perlu diperhatikan
- Kebiasaan : ............................................................................................................
- Kesehatan : ............................................................................................................
- Bahasa yang dikuasai : ............................................................................................................
13. Pengalaman dalam kepramukaan
Tahun............sebagai.....................................
Tahun............sebagai.....................................
Tahun............sebagai.....................................

14. Lain – lain


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Mengetahui Bandung, ............................................
Mabigus Calon Anggota

Hj. IAH ROPIAH, S.Pd.I ____________________________________________

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