Formulir PENDAFTARAN

Formulir Pendaftaran

Orientasi Pengenalan Pramuka OPP dan

Workshop Guru Professional

HMJ Tarbiyah STAIN Pekalongan

Bismillahirrohmanirrohim

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

NIM             : ...................................................

TTL              : ...................................................

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

No. telp./hp  : ...................................................

Motto           : ...................................................

Alamat         : ...................................................

Pengalaman organisasi            :

Intra Kampus

1. ...............................................................
2. ...............................................................

Ekstra Kampus

1. ...............................................................
2. ...............................................................

Harapan mengikuti kegiatan ini  :

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

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

Pekalongan, .... Januari 2017

                                                      TTD

(.................................)

Diisi lengkap (kesalahan Penulisan Nama / NIM bukan menjadi Tanggung Jawab Kami)