FORMULIR PENDAFTARAN

Formulir Pendaftaran

                                            Muslimah In Action 2012

Nama Sekolah / Utusan/

universitas                                : ..............................................................................

Alamat *                                   : ..............................................................................

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

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

Nama Pembina*                     : ..............................................................................

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

1. Religi Solois Nasyid

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

Umur                              :  .................................................................

Lagu yang dibawa     : ..................................................................

                                                  

2. Fahion Show Muslimah dengan tema ‘’yang Batik ya Indonesia’’

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

Umur                              :  .................................................................

NB. Segera daftarkan nama anda , karena apabila jumlah peserta melebihi qouta, pendaftaran langsung kita tutup

*) bila Umum Tidak perlu diisi