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SSB KFC

FORMULIR PENDAFTARAN
SEKRETARIAT SSB KFC SRAGEN / HP. 081 329 611 963

1. NAMA :.................................................................................

2. NAMA PANGGILAN :.................................................................................

3. TEMPAT TANGGAL LAHIR :.................................................................................

4. UMUR :.................................................................................

5. NAMA ORANG TUA :.................................................................................

6. NO TELP HP / RUMAH :.................................................................................

7. ALAMAT :.................................................................................

 RT / RW :.................................................................................

 KAMPUNG :.................................................................................

 DESA / KELURAHAN :.................................................................................

 KECAMATAN :.................................................................................

8. SEKOLAH :.................................................................................

9. KELAS :.................................................................................

Sragen, .......................................................
Orang Tua Siswa

(.................................................)
Catatan :
1. Pendaftaran : Rp. 50.000
2. Bola : Rp. 20.000
3. Iuran Bulanan : Rp. 40.000
SSB KFC
FORMULIR PENDAFTARAN
SEKRETARIAT SSB KFC SRAGEN / HP. 081 329 611 963

1. NAMA :.................................................................................

2. NAMA PANGGILAN :.................................................................................

3. TEMPAT TANGGAL LAHIR :.................................................................................

4. UMUR :.................................................................................

5. NAMA ORANG TUA :.................................................................................

6. NO TELP HP / RUMAH :.................................................................................

7. ALAMAT :.................................................................................

 RT / RW :.................................................................................

 KAMPUNG :.................................................................................

 DESA / KELURAHAN :.................................................................................

 KECAMATAN :.................................................................................

8. SEKOLAH :.................................................................................

9. KELAS :.................................................................................

Sragen, .......................................................
Orang Tua Siswa

(.................................................)
Catatan :
1. Pendaftaran : Rp. 50.000
2. Bola : Rp. 20.000
3. Iuran Bulanan : Rp. 40.000

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