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AMIL CAMP 2018

MENJADI AMIL TANGGUH


Desember 2018
& BERKEMAJUAN
ta, 7-9
akar Yogyakarta, 7-9 Desember 2018
Yogy

PERSONAL DATA
Nama Lengkap :.......................................................................................................................................
Tempat, tgl Lahir :.......................................................................................................................................

UTUSAN

LAZISMU : .....................................................................................................................................................
KONTRIBUSI
ALAMAT : .....................................................................................................................................................
SWP : Rp 750.000,- / ORANG

: .....................................................................................................................................................
Paraf dan Nama
: .....................................................................................................................................................
NO TELP/FAX : .....................................................................................................................................................
EMAIL : .....................................................................................................................................................
(………………………………………)

Nama dan nomer telepon yang dapat dihubungi sekiranya ada keadaan darurat:
Nama :
Hubungan Keluarga :
Nomer HP/WA :

DI ISI OLEH PETUGAS

PERSYARATAN AMIL CAMP KIT


1. Surat Mandat
Jumlah: .......... buah

Total SWP : Rp....................................................


AKOMODASI

BNI Syariah: Nomor Camp: ..................................................

0091 539 422 Paraf dan Nama Petugas


Tranfer pakai kode unik 025
Contoh Rp. 750.025,-
(………………………………………)

Kelengkapan Peserta yang harus dibawa:


1. Jas Hujan 2. Sleeping Bag/Matras 3. Senter
4. Jaket 5. Obat Pribadi 6. Sepatu, Sendal

Peserta terbatas & pendaftaran terakhir tanggal 30 November 2018 melalui


e-mail: info@lazismu.org
CP/WA: Tatang 0856 2475 0642

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