FORMULIR PENDAFTARAN

GEBYAR GEMURUH DAN KARNAVAL KEMERDEKAAN

NOMOR PENDAFTARAN : 48 (Diisiolehpetugaspendaftaran)

NAMA INSTANSI /ORGANISASI : SDN 02 TEGALSURUH
ALAMAT INSTANSI/ORGANISASI : TEGALSURUH SRAGI PEKALONGAN
NAMA KOORDINATOR PESERTA : WARSONO
NO WA AKTIF KOORDINATOR : 0852 2902 2844

MENDAFTAR SEBAGAI PESERTA ( *lingkarinomorkegiatan yang dipilih).

1. GEBYAR GEMURUH *
JUMLAH PESERTA : …………………………………………………………….
TEMA : ……………………………………………………………
NARASI : (ditulis di lembarnarasi)
2. KARNAVAL KEMERDEKAAN *
JUMLAH PESERTA : 20
TEMA : PROFESI
NARASI : KEGIATAN KEPROFISIONALAN

Sragi, ………. Agustus 2023

Pendaftar

( WARSONO )
LEMBAR NARASI :

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