FORMULIR-PENDAFTARAN DIKLATSAR PDF
| Title | FORMULIR-PENDAFTARAN DIKLATSAR |
|---|---|
| Author | mas Al Hakim |
| Pages | 1 |
| File Size | 203 KB |
| File Type | |
| Total Downloads | 77 |
| Total Views | 386 |
Summary
FORMULIR PENDAFTARAN RELAWAN PALANG MERAH INDONESIA KSR PMI UNIT IAIN TULUNGAGUNG A. Identitas Diri Nama : ....................................................................................................................................... NIM : ......................................................
Description
FORMULIR PENDAFTARAN RELAWAN PALANG MERAH INDONESIA KSR PMI UNIT IAIN TULUNGAGUNG A. Identitas Diri Nama NIM Tempat/Tgl lahir Jenis kelamin Kelas/Jurusan/Fakultas Alamat No Telpon/Hp Email Agama Golongan darah
: ....................................................................................................................................... : ....................................................................................................................................... : ....................................................................................................................................... : ....................................................................................................................................... : ....................................................................................................................................... : ....................................................................................................................................... ....................................................................................................................................... : ....................................................................................................................................... : ....................................................................................................................................... : ....................................................................................................................................... : .......................................................................................................................................
Riwayat Pendidikan
Riwayat Organisasi
B. Wali/orang yang dapat di Hubungi dalam keadaan darurat Nama : ....................................................................................................................................... Hubungan : ....................................................................................................................................... Alamat : ....................................................................................................................................... No Telpon/Hp : ....................................................................................................................................... Hobbi/kegiatan yang sering dilakukan: .................................................................................................................................................................................... Keahlian/ketrampilan yang dimiliki: .................................................................................................................................................................................... .................................................................................................................................................................................... Dengan ini menyatakan bersedia untuk bergabung dan mengabdikan diri dengan PALANG MERAH INDONESIA minimal 3 tahun berturut-turut. Tulungagung, ... …………………. 2017 Foto 3x4
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