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SMAN 1 Bekasi

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 : ............................................................................................
..............................................................................................
..............................................................................................
Kode Pos: ................................... Telp.: ..............................

2. DATA GURU PEMBIMBING

Nama : ..............................................................................................
NIP. : ..............................................................................................

3. DATA SEKOLAH

Nama : ............................................................................................
Alamat : ............................................................................................
..............................................................................................
..............................................................................................
Kode Pos: ................................... Telp.: ..............................

(Formulir dapat di fotocopy atau diperbanyak)

Mengetahui,

Guru Pembimbing.........................................
SMAN 1 Bekasi

FM – KSW – 15.6

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