FM – KSW – 15.6
FORMULIR PENDAFTARAN
LOMBA DEBAT BAHASA INDONESIA
TINGKAT SMA/MA SE-JAWA BARAT, DKI JAKARTA, DAN BANTEN
1. DATA PESERTA
FOTO
3x4
Ketua Kelompok
Nama : ............................................................................................
Kelas : ............................................................................................
Alamat : ............................................................................................
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Kode Pos: ................................... Telp.: ..............................
FOTO
3x4
Anggota I
Nama : ............................................................................................
Kelas : ............................................................................................
Alamat : ............................................................................................
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Kode Pos: ................................... Telp.: ..............................
SMAN 1 Bekasi
FM – KSW – 15.6
FOTO
3x4
Anggota II
Nama : ............................................................................................
Kelas : ............................................................................................
Alamat : ............................................................................................
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Kode Pos: ................................... Telp.: ..............................
Nama : ..............................................................................................
NIP. : ..............................................................................................
3. DATA SEKOLAH
Nama : ............................................................................................
Alamat : ............................................................................................
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Kode Pos: ................................... Telp.: ..............................
Mengetahui,
Guru Pembimbing.........................................
SMAN 1 Bekasi
FM – KSW – 15.6
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