IDENTITAS

PESERTA EXTRA BAND

Nama: ................................................................................

Jenis Kelamin: ................................................................................

Tempat,Tanggal Lahir: ................................................................................

Kelas/Jurusan: ................................../..............................................

Alamat lengkap: ................................................................................

.................................................................................

No.HP/Telp: ................................................................................

Minat: ................................................................................

Bakat: ................................................................................

Alasan: ................................................................................

..................................................................................

..................................................................................

Nama orang tua: .................................................................................

Ijin orang tua: .................................................................................

(Foto4 X 6)

1. Wajib Mentaati peraturan

2. Wajib hadir

3. Wajib membayar kas sesuai ketentuan

Susah senang bersama...