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IDENTITAS

PESERTA EXTRA BAND

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

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

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

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

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

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

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

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

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

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1. Wajib Mentaati peraturan

2. Wajib hadir

3. Wajib membayar kas sesuai ketentuan

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