FORMULIR PENDAFTARAN
No. Pendaftaran* :____________________________________________________________
Nama Lengkap :____________________________________________________________
TTL :____________________________________________________________
NBM/NIA :____________________________________________________________
Asal Komisariat :____________________________________________________________
Asal Cabang :____________________________________________________________
Email :____________________________________________________________
No. Hp :____________________________________________________________
Alamat :____________________________________________________________
:____________________________________________________________
Motivasi Mengikuti :____________________________________________________________
Sekolah Kader :____________________________________________________________
Mubaligh :____________________________________________________________
:____________________________________________________________
Nama Lengkap
*) oleh panitia pelaksana