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    dari 1

    CALON ANGGOTA BASKET

    SMAN 1 TUMIJAJAR
    Jend. Sudirman No 92 Dayamurni Kec. Tumijajar Kab. Tulang Bawang Barat Telp (0721)351346

    FORMULIR PENDAFTARAN

    NAMA LENGKAP : ......................................................................................................................

    JENIS KELAMIN : .......................................................................................................................

    TTL : .......................................................................................................................

    ALAMAT : ......................................................................................................................

    AGAMA : .......................................................................................................................

    HOBI DAN BAKAT : .......................................................................................................................

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

    NO HP : .......................................................................................................................

    CITA-CITA : .........................................................................................................................

    PENGALAMAN ORGANISASI : .......................................................................................................................

    .......................................................................................................................

    PRESTASI YANG PERNAH DIRAIH : .......................................................................................................................

    .......................................................................................................................

    TUJUAN MASUK ROHIS : .......................................................................................................................

    .......................................................................................................................

    .......................................................................................................................

    MOTTO HIDUP : .......................................................................................................................

    Dayamurni,........Juli 2023

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    Siswa Orang Tua/Wali

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