Form Pendaftaran HSN CBD

PANITIA PERINGATAN HARI SANTRI NASIONAL
MAJELIS WAKIL CABANG NAHDLATUL ULAMA

KECAMATAN CIBADAK
Sekretariat : Jl. K Ihi Syamsuri RT 002 RW 020 Kel, Cibadak,
Kec, Cibadak43155, Kab, Sukabumi Jawa Barat
FORMULIR PENDAFTARAN FUTSALL

1. Nama Tim :...............................................................................
2. Asal Madrasah/Pesantren :...............................................................................
3. Alamat Sekolah : ..............................................................................
4. Nama Penanggung Jawab :..............................................................................
5. No. HP Penanggung Jawab :.............................................................................
Nama Tim : .................................................

Asal Sekolah : .................................................
1. Nama : ........................................................
TTL : ........................................................
Kelas : .........................................................
Umur : .........................................................
2. Nama : ........................................................
TTL : ........................................................
Kelas : .........................................................
Umur : .........................................................
3. Nama : ........................................................
TTL : ........................................................
Kelas : .........................................................
Umur : .........................................................
4. Nama : ........................................................
TTL : ........................................................
Kelas : .........................................................
Umur : .........................................................
5. Nama : ........................................................
TTL : ........................................................
Kelas : .........................................................
Umur : .........................................................
6. Nama : ........................................................
TTL : ........................................................
Kelas : .........................................................
Umur : .........................................................
7. Nama : ........................................................
TTL : ........................................................
Kelas : .........................................................
Umur : .........................................................
8. Nama : ........................................................
TTL : ........................................................
Kelas : .........................................................
Umur : .........................................................
9. Nama : ........................................................
TTL : ........................................................
Kelas : .........................................................
Umur : .........................................................
10. Nama : ........................................................
TTL : ........................................................
Kelas : .........................................................
Umur : .........................................................
Adapun semua data yang kami lampirkan adalah benar adanya dan tidak
menyalahi Peraturan Pekan Olahraga dan Perlombaan Hari santri Nasional MWC
NU CIbadak.
Cibadak, ....September 20222

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN TENIS MEJA PUTRA
1. Nama Peserta :...............................................................................

2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
3. Alamat Madrasah :..............................................................................
NU CIbadak.

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN TENIS MEJA PUTRI
1. Nama Peserta :...............................................................................

2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
3. Alamat Madrasah :..............................................................................
NU CIbadak.

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN LOMBA CERDAS CERMAT
1. Nama Regu :...............................................................................

3. Alamat Sekolah : ..............................................................................
5. No. HP Penanggung Jawab :..............................................................................
1. Nama Peserta 1 :...............................................................................

2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
1. Nama Peserta 2 :...............................................................................

2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
1. Nama Peserta 3 :...............................................................................

2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
NU CIbadak.

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN LOMBA PIDATO B. Indonesia PUTRA

1. Nama Peserta :...............................................................................
2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
3. Alamat Madrasah :..............................................................................
NU CIbadak.

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN LOMBA PIDATO B. Indonesia PUTRI

1. Nama Peserta :...............................................................................
2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
3. Alamat Madrasah :..............................................................................
NU CIbadak.

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN LOMBA PIDATO B. Sunda PUTRA

1. Nama Peserta :...............................................................................
2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
3. Alamat Madrasah :..............................................................................
NU CIbadak.

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN LOMBA PIDATO B. Sunda PUTRI

1. Nama Peserta :...............................................................................
2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
3. Alamat Madrasah :..............................................................................
NU CIbadak.

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN LOMBA MUSABAQOH HIFDZIL QUR’AN PUTRA
1. Nama Peserta :...............................................................................

2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
3. Alamat Madrasah :..............................................................................
NU CIbadak.

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN LOMBA MUSABAQOH HIFDZIL QUR’AN PUTRI
1. Nama Peserta :...............................................................................

2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
3. Alamat Madrasah :..............................................................................
NU CIbadak.

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN LOMBA MUSABAQOH QIRAATUL QUTUB PUTRA
1. Nama Peserta :...............................................................................

2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
3. Alamat Madrasah :..............................................................................
NU CIbadak.

Penanggung Jawab
.............................................
KECAMATAN CIBADAK
FORMULIR PENDAFTARAN LOMBA MUSABAQOH QIRAATUL QUTUB PUTRI
1. Nama Peserta :...............................................................................

2. TTL :...............................................................................
3. Umur :...............................................................................
4. Jenis Kelamin :...............................................................................
3. Alamat Madrasah :..............................................................................
NU CIbadak.

Penanggung Jawab
.............................................

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PANITIA PERINGATAN HARI SANTRI NASIONAL

MAJELIS WAKIL CABANG NAHDLATUL ULAMA

FORMULIR PENDAFTARAN FUTSALL

Nama Tim : .................................................

Cibadak, ....September 20222

FORMULIR PENDAFTARAN TENIS MEJA PUTRA

1. Nama Peserta :...............................................................................

Cibadak, ....September 20222

FORMULIR PENDAFTARAN TENIS MEJA PUTRI

1. Nama Peserta :...............................................................................

Cibadak, ....September 20222

FORMULIR PENDAFTARAN LOMBA CERDAS CERMAT

1. Nama Regu :...............................................................................

1. Nama Peserta 1 :...............................................................................

1. Nama Peserta 2 :...............................................................................

1. Nama Peserta 3 :...............................................................................

Cibadak, ....September 20222

FORMULIR PENDAFTARAN LOMBA PIDATO B. Indonesia PUTRA

Cibadak, ....September 20222

FORMULIR PENDAFTARAN LOMBA PIDATO B. Indonesia PUTRI

Cibadak, ....September 20222

FORMULIR PENDAFTARAN LOMBA PIDATO B. Sunda PUTRA

Cibadak, ....September 20222

FORMULIR PENDAFTARAN LOMBA PIDATO B. Sunda PUTRI

Cibadak, ....September 20222

FORMULIR PENDAFTARAN LOMBA MUSABAQOH HIFDZIL QUR’AN PUTRA

1. Nama Peserta :...............................................................................

Cibadak, ....September 20222

FORMULIR PENDAFTARAN LOMBA MUSABAQOH HIFDZIL QUR’AN PUTRI

1. Nama Peserta :...............................................................................

Cibadak, ....September 20222

FORMULIR PENDAFTARAN LOMBA MUSABAQOH QIRAATUL QUTUB PUTRA

1. Nama Peserta :...............................................................................

Cibadak, ....September 20222

FORMULIR PENDAFTARAN LOMBA MUSABAQOH QIRAATUL QUTUB PUTRI

1. Nama Peserta :...............................................................................

Cibadak, ....September 20222

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