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GERAKAN PRAMUKA GERAKAN PRAMUKA

KWARTIR CABANG SERDANG BEDAGAI KWARTIR CABANG SERDANG BEDAGAI


Sekretariat : Jl. Negara No. 300 Sei Rampah - Sumatera Utara Kode Pos : 20995 Sekretariat : Jl. Negara No. 300 Sei Rampah - Sumatera Utara Kode Pos : 20995

FORMULIR PENDAFTARAN FORMULIR PENDAFTARAN


CALON PENDONOR DARAH PADA PERINGATAN HARI PRAMUKA KE 60 CALON PENDONOR DARAH PADA PERINGATAN HARI PRAMUKA KE 60

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


Tempat, tanggal lahir : ............................................................................................ Tempat, tanggal lahir : ............................................................................................
Jenis kelamin : ............................................................................................ Jenis kelamin : ............................................................................................
Agama : ............................................................................................ Agama : ............................................................................................
Golongan darah : ............................................................................................ Golongan darah : ............................................................................................
Berat Badan : ............................................................................................ Berat Badan : ............................................................................................
Usia : ............................................................................................ Usia : ............................................................................................
Gugusdepan : ............................................................................................ Gugusdepan : ............................................................................................
Pangkalan : ............................................................................................ Pangkalan : ............................................................................................
Kwaran/Kwarcab : ............................................................................................ Kwaran/Kwarcab : ............................................................................................
Alamat rumah : ............................................................................................ Alamat rumah : ............................................................................................
............................................................................................ ............................................................................................
Nomor HP : ............................................................................................ Nomor HP : ............................................................................................

Dengan suka dan rela bersedia untuk mendonorkan darah dalam rangka Peringatan Dengan suka dan rela bersedia untuk mendonorkan darah dalam rangka Peringatan
Hari Pramuka ke 60 tahun 2021. Hari Pramuka ke 60 tahun 2021.

Sei Rampah, Agustus 2021 Sei Rampah, Agustus 2021

Pendonor, Pendonor,

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