FORMULIR PENDAFTARAN

OSIS SMA NEGERI 9 PALEMBANGTEATER KOSONGSEMBILANJalan Mataram Kel. Kemas Rindo Kec. Kertapati Palembang

FORMULIR PENDAFTARAN ANGGOTA BARUANGKATAN XXV (2015/2016)Nama Lengkap:...................................................................................................................

Nama Panggilan:...................................................................................................................

Tempat/Tanggal Lahir:...................................................................................................................

Jenis Kelamin:Laki-Laki/Perempuan*

Kelas:...................................................................................................................

Agama:...................................................................................................................

Alamat Tinggal:...................................................................................................................

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Nomor Telepon/HP:...................................................................................................................

Bakat dibidang seni:...................................................................................................................

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Prestasi dalam bidang seni:...................................................................................................................

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Pengalaman berteater:...................................................................................................................

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Motivasi mengikuti Teater

Kosongsembilan:...................................................................................................................

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Salinlah! ...................................................................................................................

Demikian data ini saya isikan dengan sebenar-benarnya secara sadar, tanpa ada paksaan dari pihak manapun. Setelah menjadi anggota Teater Kosongsembilan saya akan menuruti segala tata tertib yang berlaku, dan bersedia menerima sanksi bila terbukti saya melanggar tata tertib tersebut.

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No. Registrasi: 025-201507-0

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