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KOP SURAT

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DATA ATLET

No Anggota KONI : .................................................... Tanggal Daftar : ......................................................


Nama Lengkap : .................................................... NIK : ....................................................
Jenis Kelamin : .................................................... Agama : ....................................................
Tanggal Lahir : .................................................... Alamat : ....................................................
Tempat : .................................................... : ......................................................
Golongan darah : .................................................... RT / RW : ....................................................
Pendidikan terakhir : .................................................... Kelurahan : ....................................................
Pekerjaan : .................................................... Kecamatan : ....................................................
Status atlet : .................................................... Kab. / Kota : ....................................................
Telp / HP : .................................................... Provinsi : ....................................................
Email : .................................................... Kode Pos : ........................................................
No. Pasport : .................................................... Alamat Surat : ....................................................
Masa Berlaku Pasport : .................................................... : ....................................................
Masa Berlaku Pasport : .................................................... Kode Cabor : ........................................................
Status Perkawinan : .................................................... Nama Cabor : ....................................................

DATA FISIK
Tinggi Badan : .................................................... Berat Badan : ....................................................
Size Sepatu : .................................................... Size Topi : ........................................................
Size T-hirt : .................................................... Size Training : ....................................................
Size Jaket : .................................................... Size Celana : ....................................................
PENGCAB POSSI …………………….
Ketua,

(…………………………………..)

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