Anda di halaman 1dari 1

PIMPINAN CABANG

FATAYAT NAHDLATUL
ULAMA
SURABAYA
JL.Bubutan VI No. 2 Surabaya Telp. . 081216478418, 0813305970
Email: pcfatayatnu.kota surabaya@gmail.com

FATAYAT NAHDLATUL ULAMA


FORMULIR PENDAFTARAN ANGGOTA BARU

Nama : .......................................................................................................................
Tempat/Tanggal Lahir : .......................................................................................................................
Alamat : .......................................................................................................................
Telepon : .................................................................................................
Faksimile : .................................................................................................
Hp. : .................................................................................................
e-mail : .................................................................................................
Pendidikan : .......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
Pengalaman Organisasi : .......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
.......................................................................................................................
Pekerjaan : .......................................................................................................................
.......................................................................................................................
Motivasi mengikuti fatayat : .......................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................
........................................................................................................................

(............................................)
Nama lengkap dengan gelar

Anda mungkin juga menyukai