BIODATA PESERTA

LOMBA MENDONGENG TINGKAT SD / MI TAHUN 2023

NAMA : ....................................................................................

TEMPAT, TANGGAL LAHIR : ....................................................................................

ALAMAT RUMAH : ....................................................................................

NO. TELEPON / HP : ....................................................................................

KELAS : ....................................................................................

ASAL SEKOLAH : ....................................................................................

ALAMAT SEKOLAH : ....................................................................................

ASAL TBM : ....................................................................................

NAMA ORANG TUA

AYAH : ....................................................................................

IBU : ....................................................................................

NO. TELEPON / HP :....................................................................................

JUDUL CERITA : ....................................................................................

SUMBER CERITA : ....................................................................................

Surabaya, Januari 2023

Pendaftar,

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