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PANITIA PELAKSANA LATIHAN KADER 1

KARANG TARUNA INDONESIA


KECAMATAN GALESONG SELATAN
PERIODE 2021-2026
Sekretariat : Jl. Poros Galesong Selatan, Desa Bontokassi, Telp/WA : 085340244361

FORMULIR PENDAFTARAN
CALON PESERTA LATIHAN KADER 1
ANGKATAN 1 KARANG TARUNA INDONESIA
KECAMATAN GALESONG SELATAN

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


Nama Panggilan :.....................................................................................................
Tempat Tgl. Lahir :.....................................................................................................
Agama : ....................................................................................................
Jenis Kelamin : ....................................................................................................
No. NIK : ....................................................................................................
Gol. Darah :..................
Pekerjaan : :.....................................................................................................
Nomor Hp/wa : ....................................................................................................
Alamat :.....................................................................................................
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Alasan Mengikuti LK1: ....................................................................................................
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*Syarat dan Ketentuan
 Sehat Jasmani dan Rohani
 Usia 11 s/d 45 Tahun Calon Peserta
 Berdomisili di Takalar
 Punya Tanda Pengenal (KTP/KK)
 Konstribusi 25k

*Isi Dengan Huruf Kapital

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