Jumat, 29 Oktober 2010

Formulir Pendaftaran Napak Tilas Ryacudu IV

FORMULIR PENDAFTARAN
NAPAK TILAS RYACUDU-IV
TINGKAT NASIONAL
KABUPATEN WAY KANAN
TAHUN 2010



Nomor Team                           : .................................................(kosongkan)
Nama Team                             : .................................................
Utusan OKP/Instansi/Umum     : .................................................
Alamat                                     : .................................................
No HP/Telpon                         : .................................................

Nama Ketua Team                  : .................................................
                                Anggota   1 ...............................................
                                                2 ..............................................
                                                3 ..............................................
                                                4 ..............................................
Biaya Pendaftaran                     : Rp. 50.000 (Lima Puluh Ribu Rupiah)

                                                                         .........................,.....November 2010

                          Ketua Team                                                  Panitia



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

Note :
Contoh Formulir Pendaftaran Napak Tilas Ryacudu-IV via Email (napaktilasrc4@gmail.com)

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