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Sekretaiat Masjid Baiturrahman Pesisir Gg, 03, Kilensari, Panarukan, Situbondo.

No. Hp : 0852 5885 4972

FORMULIR PENDAFTARAN
KURSUS BAHASA ARAB

A. JENJANG SEKOLAH
Beri tanda silang
TK/RA
SD/MI
SMP/MTs
SMA/MA
SMK/MAK
Mahasiswa FKIP/LPTK

B. KETERANGAN PERORANGAN
1. Nama Lengkap : _________________________________
2. NIP/NIM : _________________________________
3. Nama Sekolah/Universitas : _________________________________
4. Alamat Sekolah/Universitas : _________________________________
5. Alamat Rumah : _________________________________
6. E-Mail : _________________________________

C. Tujuan mengikuti Kursus Bahasa Arab


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D.
NO. BULAN Rp.
1 Bulan ke... Rp.
2 Bulan ke... Rp.
3 Bulan ke... Rp.
4 Bulan ke... Rp.
5 Bulan ke... Rp.

Nb:
 Formulir ini bisa diperbanyak sendiri.

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