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    Student Registration Form: Sma Negeri 3 Kotabumi

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    nurinuryani
    This document contains a student registration form with fields for student information like name, address, date of birth, parents' information. It collects details like name, gender, address, phone number, email, hobbies, parents' name, occupation, address.

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    Student Registration Form: Sma Negeri 3 Kotabumi

    Uploaded by

    nurinuryani
    13 views1 page
    This document contains a student registration form with fields for student information like name, address, date of birth, parents' information. It collects details like name, gender, address, phone number, email, hobbies, parents' name, occupation, address.

    Original Title

    TUGAS BHS INGGRIS LM 2-Copy

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    This document contains a student registration form with fields for student information like name, address, date of birth, parents' information. It collects details like name, gender, address, phone number, email, hobbies, parents' name, occupation, address.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    13 views1 page

    Student Registration Form: Sma Negeri 3 Kotabumi

    Uploaded by

    nurinuryani
    This document contains a student registration form with fields for student information like name, address, date of birth, parents' information. It collects details like name, gender, address, phone number, email, hobbies, parents' name, occupation, address.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
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    PEMERINTAH PROVINSI LAMPUNG

    DINAS PENDIDIKAN DAN KEBUDAYAAN


    SMA NEGERI 3 KOTABUMI
    Jalan Sersan Laba Gole No. 45 Kota Alam, Kotabumi 34519 Tlp.(0724) 23802
    Email : [email protected] NPSN : 10803026 NSS : 304120301063

    STUDENT REGISTRATION FORM

    STUDENT INFORMATION. Complete the information below.

    Name Muhammad iqbal alkausar gusmar


    : ________________________________________
    Address Jl.moh.tahir.No 535
    : _____________________________________________________________
    _____________________________________________________________
    Gender : □ Male □ Female
    Place of Birth Kotabumi
    : __________________
    Date of Birth
    1 ____/
    (Month/Day/Year) : ____/ 2006
    14 _______

    Graduated from SMP N 1 KOTABUMI


    : _____________________________
    Phone Number 089628877053
    : _____________________________
    Email Address [email protected]
    : _____________________________
    Hobbies Basketball
    : ____________________________________________________________

    PARENT’S INFORMATION
    Father’s Name Budimawardi
    : ________________________________________
    Wiraswasta
    Father’s Occupation : ________________________________________
    Father’s Address Jl.moh.tahir.NO535
    : _____________________________________________________________
    _____________________________________________________________
    Mother’s Name Gusmiati
    : ____________________________
    PNS
    Mother’s Occupation : ____________________________
    Mother’s Address Jl.moh.tahir.NO535
    : _____________________________________________________________
    _____________________________________________________________

    Student’s Signature

    Muhammad iqbal
    Name : ________________
    9 Agustus 2021
    Date : ________________

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