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LESTARA ENGLISH COURSE

MAKE IT EASY

FORMULIR PENDAFTARAN
REGISTRATION FORM

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


Nama Panggilan :...........................................................................................................
Jenis Kelamin :...........................................................................................................
Tempat & Tanggal Lahir :...........................................................................................................
Agama :...........................................................................................................
Nama Sekolah :...........................................................................................................
Nama Bapak :...........................................................................................................
Nama Ibu :...........................................................................................................
Pekerjaan Orang Tua :...........................................................................................................
Alamat :...........................................................................................................
............................................................................................................
............................................................................................................
No. Telp/Handphone :...........................................................................................................

Catatan :
Formulir Pendaftaran harus dikembalikan disertai biaya pendaftaran + Iuran bulan pertama

Poso,... ... ... ... ... .... 2012

M. DZULFAHMI AZIZ

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