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GERAKAN PRAMUKA

GUGUS DEPAN KOTA SERANG 01.371


GUGUS DEPAN KOTA SERANG 01.372
BERPANGKALAN PADA UNIVERSITAS PRIMAGRAHA
Komplek Grya Gemilang Sakti, Jl. Trip Jamaksari Blok A1 No. 1A, Kaligandu
Kec. Serang, Kota Serang, Banten 42111

FORMULIR PENDAFTARAN
KEMAH MASA ORIENTASI TAMU RACANA (KEMORA) 4
TAHUN 2023

Nama Lengkap : ..................................................................


Nama Panggilan : ..................................................................
Jenis Kelamin : ..................................................................
Tempat, Tgl Lahir : .................................................................. Pas Photo
Agama : .................................................................. 4x6
Hp : ..................................................................
E-Mail : ..................................................................
Program Studi : ..................................................................
NIM : ..................................................................
Sosial Media :Instagram: .......................................................................................
Facebook: ........................................................................................
Golongan Pramuka : ........................................................................................................
Alamat Identitas : ........................................................................................................
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Alamat Saat Ini : Isikan Jika Tempat Tinggal Anda Saat Ini (Kost/Asrama/Mes/Pondok Pesantren)
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Motto Hidup : ........................................................................................................


Motivasi Mengikuti KEMORA 4 : .......................................................................................
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Serang, ………………… 2023


Peserta KEMORA 4

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