PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

Nama Regu : SUNAN KALIJOGO

Jumlah Peserta : ____________________________
Hari/Tanggal : ____________________________
Materi : ____________________________
No/Nama NO. HP TTD

1. Hendra Saputra ___________________ 1________

2. Lukman Fajar Setiawan _ 2________
3. Niko Saiful Huda ___________________ 3________
4. Mahfud Dardiri _ 4________
5. Widi Atmoko ___________________ 5________
6. Agus Budianto _ 6________
7. Sutrisno Pamor Aji Pangestu ___________________ 7________
8. Ahmad Maksum _ 8________
9. Khoirun Bagus Setiawan ___________________ 9________
10. Muh. Romdhoni DNF _ 10________
11. ______________________________ ___________________ 11________
_ _ 12________
12. ______________________________ ___________________ 13_______
_ _ _ 14________
13. ______________________________ ___________________
_ _ 15_______
14. ______________________________ ___________________ _
_ _
15. ______________________________ ___________________
_ _
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

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Nama Regu : SYEH ABDUL QADIR AL JAILANI

Jumlah Peserta : ____________________________
Hari/Tanggal : ____________________________
Materi : ____________________________
No/Nama NO. HP TTD

1. Suyanto ___________________ 1________

2. Tumirin _ 2________
3. Rizky Ata’ala Mustafid ___________________ 3________
4. Miftahus Sururi _ 4________
5. Rizaludin Ahlan ___________________ 5________
6. Farid Miftahuddin _ 6________
7. Mohamad Choirul Huda ___________________ 7________
8. Langgeng Widodo _ 8________
9. Anggri Fri Agung Saputra ___________________ 9________
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

10. Hendi Tri Wibowo _ 10________

11. M. Rizal Aswarian ___________________ 11________
12. ______________________________ _ 12________
_ ___________________ 13_______
13. ______________________________ _ _ 14________
_ ___________________
14. ______________________________ _ 15_______
_ ___________________ _
15. ______________________________ _
_ ___________________
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_
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

Nama Regu : SUNAN AMPEL

Jumlah Peserta : ____________________________
Hari/Tanggal : ____________________________
Materi : ____________________________
No/Nama NO. HP TTD

1. Moh Bahronil M. ___________________ 1________

2. Imam Asrori _ 2________
3. Dedi Hardianto ___________________ 3________
4. Choirul Mustofa _ 4________
5. Ubaid Sirojudin A. ___________________ 5________
6. Khamim Jazuli _ 6________
7. Imam Rahmad S. ___________________ 7________
8. Indra Jaya _ 8________
9. Agus Rianto ___________________ 9________
10. Yasin _ 10________
11. ______________________________ ___________________ 11________
_ _ 12________
12. ______________________________ ___________________ 13_______
_ _ _ 14________
13. ______________________________ ___________________
_ _ 15_______
14. ______________________________ ___________________ _
_ _
15. ______________________________ ___________________
_ _
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

16. ______________________________ ___________________

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_
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

Nama Regu : KH. HASAN BESARI

Jumlah Peserta : ____________________________
Hari/Tanggal : ____________________________
Materi : ____________________________
No/Nama NO. HP TTD

1. Bayu Aji Romdhoni ___________________ 1________

2. Masrur Afandi _ 2________
3. Bayu Kurdianto ___________________ 3________
4. Gandung Fajar Santoso _ 4________
5. Sukadi ___________________ 5________
6. M. Adib _ 6________
7. Eko Prasetyo ___________________ 7________
8. Irfan Nawawi _ 8________
9. Agus Supriyanto ___________________ 9________
10. M. Ma’ruf Tomy K. _ 10________
11. Misni ___________________ 11________
12. ______________________________ _ 12________
_ ___________________ 13_______
13. ______________________________ _ _ 14________
_ ___________________
14. ______________________________ _ 15_______
_ ___________________ _
15. ______________________________ _
_ ___________________
_
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

___________________
_
___________________
_
___________________
_
___________________
_
___________________
_
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

Nama Regu : HASYIM ASHARI

Jumlah Peserta : ____________________________
Hari/Tanggal : ____________________________
Materi : ____________________________
No/Nama NO. HP TTD

1. Ahmad Khoirul M. ___________________ 1________

2. Dharma Septian Nugroho _ 2________
3. Muhammad Zainul Fadli ___________________ 3________
4. Tukiran _ 4________
5. Dedi Harmadi ___________________ 5________
6. Muhammad Masrukin _ 6________
7. Arifin ___________________ 7________
8. Arip Prasetyo Wicaksono _ 8________
9. Muklis Khudori ___________________ 9________
10. Suparto _ 10________
11. ______________________________ ___________________ 11________
_ _ 12________
12. ______________________________ ___________________ 13_______
_ _ _ 14________
13. ______________________________ ___________________
_ _ 15_______
14. ______________________________ ___________________ _
_ _
15. ______________________________ ___________________
_ _
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

___________________
_
___________________
_
___________________
_
___________________
_
___________________
_
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

Nama Regu : GUS MA’SUM

Jumlah Peserta : ____________________________
Hari/Tanggal : ____________________________
Materi : ____________________________
No/Nama NO. HP TTD

1. Agus Saifudin ___________________ 1________

2. Suparno _ 2________
3. Risqi Imron Kurniawan ___________________ 3________
4. Samroji _ 4________
5. Duwi Febriyanto ___________________ 5________
6. Muhammad Fatkur Rahman _ 6________
7. Yusuf Eko Cahyono ___________________ 7________
8. Rudi Purnomo _ 8________
9. Tukino ___________________ 9________
10. M. Alrizal AP. _ 10________
11. ______________________________ ___________________ 11________
_ _ 12________
12. ______________________________ ___________________ 13_______
_ _ _ 14________
13. ______________________________ ___________________
_ _ 15_______
14. ______________________________ ___________________ _
_ _
15. ______________________________ ___________________
_ _
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

___________________
_
___________________
_
___________________
_
___________________
_
___________________
_
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

Nama Regu : GUSDUR

Jumlah Peserta : ____________________________
Hari/Tanggal : ____________________________
Materi : ____________________________
No/Nama NO. HP TTD

1. Wahyu P. ___________________ 1________

2. M. Badrul F. _ 2________
3. M. Syarif ___________________ 3________
4. Sutrisno _ 4________
5. M. Ibnu Mahaka ___________________ 5________
6. Jamaluddin _ 6________
7. Muh. Syaifudin ___________________ 7________
8. Arif Ahmadi _ 8________
9. M. Sholihudin ___________________ 9________
10. Ali Mustakim _ 10________
11. Alif Febriyama ___________________ 11________
12. ______________________________ _ 12________
_ ___________________ 13_______
13. ______________________________ _ _ 14________
_ ___________________
14. ______________________________ _ 15_______
_ ___________________ _
15. ______________________________ _
_ ___________________
_
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

___________________
_
___________________
_
___________________
_
___________________
_
___________________
_
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

Nama Regu : BISRI SAMSURI

Jumlah Peserta : ____________________________
Hari/Tanggal : ____________________________
Materi : ____________________________
No/Nama NO. HP TTD

1. Uswatun Binti Shalikah ___________________ 1________

2. Faiq Alfilatul Ullya _ 2________
3. Ainul Nurhayati Istiqomah ___________________ 3________
4. Erica Nandita Putri _ 4________
5. Vivitya Sahrohani ___________________ 5________
6. Sulis _ 6________
7. ______________________________ ___________________ 7________
_ _ 8________
8. ______________________________ ___________________ 9________
_ _ 10________
9. ______________________________ ___________________ 11________
_ _ 12________
10. ______________________________ ___________________ 13_______
_ _ _ 14________
11. ______________________________ ___________________
_ _ 15_______
12. ______________________________ ___________________ _
_ _
13. ______________________________ ___________________
_ _
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

14. ______________________________ ___________________

_ _
15. ______________________________ ___________________
_ _
___________________
_
___________________
_
___________________
_
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

Nama Regu : WAHAB CHASBULLOH

Jumlah Peserta : ____________________________
Hari/Tanggal : ____________________________
Materi : ____________________________
No/Nama NO. HP TTD

1. Dwi Purnamasari ___________________ 1________

2. Ayu Purnawati _ 2________
3. Zulfika ___________________ 3________
4. Anting Wulan _ 4________
5. Alif Hidayati ___________________ 5________
6. ______________________________ _ 6________
_ ___________________ 7________
7. ______________________________ _ 8________
_ ___________________ 9________
8. ______________________________ _ 10________
_ ___________________ 11________
9. ______________________________ _ 12________
_ ___________________ 13_______
10. ______________________________ _ _ 14________
_ ___________________
11. ______________________________ _ 15_______
_ ___________________ _
12. ______________________________ _
_ ___________________
13. ______________________________ _
 PANITIA PELAKSANA

DIKLAT TERPADU DASAR BANSER

PAC. GERAKAN PEMUDA ANSOR

S U K O R E J O
Alamat : Kantor MWC NU Sukorejo Telp. 081249556911

34-XII

_ ___________________
14. ______________________________ _
_ ___________________
15. ______________________________ _
_ ___________________
_
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_