FORM
PENDAFTARAN
PESERTA
JAMBOREE REMAJA MASJID MUHAMMADIYAH 2014
SE-KOTA
YOGYAKARTA
Nama
Kelompok : ...................................................................................................
Asal
Masjid/Musholla : ...................................................................................................
(Ranting, Cabang)
*Contoh: Masjid Al-Ishlaah, Nitikan, Umbulharjo.
Alamat Lengkap Masjid : ...................................................................................................
...................................................................................................
...................................................................................................
...................................................................................................
Kategori
Kelompok : Putra / Putri
*Coret
Salah satu
Ketua
Kelompok : ...................................................................................................
Anggota
Kelompok :
1. ..........................................................................................
2. ..........................................................................................
3. ..........................................................................................
4. ..........................................................................................
5. ..........................................................................................
6. ..........................................................................................
7. .......................................................................................... 8.
9. ..........................................................................................
Contact
Person Kelompok : ...................................................................................................
Email
dan Website : ...................................................................................................
……………………., ……………2014
Nama Ketua Kelompok
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*Form ini dapat digandakan sesuai dengan jumlah kelompok yang ikut serta
dalam kegiatan JAMBOREE.