FORMULIR PENDAFTARAN
ANGGOTA PALANG MERAH REMAJA
SMK TARUNA BHAKTI
Nama :...........................................................................................................
Kelas :...........................................................................................................
Asal Sekolah :...........................................................................................................
Jenis
kelamin :...........................................................................................................
T. T. L :...........................................................................................................
Agama :...........................................................................................................
Golongan
Darah :...........................................................................................................
No HP :...........................................................................................................
Email :...........................................................................................................
Motivasi
mengikuti PMR :...........................................................................................................
Dengan ini menyatakan ingin menjadi
anggota Palang Merah Remaja SMK TARUNA BHAKTI.
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Kadugede,..............................2013
Peserta
(.................................................)
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