TURNAMEN FUTSAL KARANG TARUNA

BINA KARYA PERKASA DESA JANGKANG BARU

FORMULIR PENDAFTARAN

Saya yang bertanda tangan di bawah ini :

Nama : …………………….............
Jabatan : …………………….............
Nomor HP. : …………………................

Menyatakan bahwa saya atas Nama Club/ Perwakilan Desa Bertanggung Jawab Penuh
mendaftarkan Club Futsal Kami untuk mengikuti Turnamen Futsal Karang Taruna Bina
Karya Perkasa Desa Jangkang Baru Tahun 2023, dengan keterangan sebagai berikut :

Nama Club / Team : ……………………….....

Alamat / Desa : ………………………......

Dengan ini menyatakan bahwa Nama Club / Team Futsal dari Desa kami diatas menjadi
Peserta dan bersedia bekerjasama dengan Panitia dan mengikuti semua Aturan dari Panitia
Penyelenggara demi kelancaran dan guna mensukseskan serta Memeriahkan Turnamen Futsal
Bina Karya Perkasa Desa Jangkang Baru Tahun 2023.

........................................, ...... Juni 2023

Hormat Kami

………………………………….

Catatan :

Adapun Peraturan Tata Tertib yang harus di sepakati dan ditaati semua peserta disepakati pada
saat Technical Meeting berlangsung apabila Aturan dan Tata Tertib dilanggar demi
kenyamanan kita bersama maka akan ada sangsi hukum nantinya yang harus disepakati bersama.
 Nama : .................................................................................................................
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Tempat, Tanggal Lahir : .................................................................................................................

Alamat sesuai KTP : .................................................................................................................

Nomor Punggung : .................................................................................................................