FORMULIR PENDAFTARAN LOMBA MINAT BACA

FORMULIR PENDAFTARAN

IDENTITAS PESERTA                

Nama                                               : Masniari Gea

Tempat / Tanggal Lahir                    : Fulolo I, 7-1-2004

Umur                                                : 11 Tahun

Jenis Kelamin                                   : Perempuan

Alamat                                             : Jl.                                          : Beringin

                                                           Desa                                     : Fulolosalo’o

                                                           Kecamatan                           : Sitolu Ori

                                                           Kabupaten                            : Nias Utara

Agama                                             : Kristen Protestan

Pendidikan                                       : SD

Asal Sekolah                                    : SDN No. 071029 Fulolosalo’o

Kelas                                                : 6

Nama Pembimbing                          : Saritia Telaumbanua

Nomor handphone                           :

                                                                                                        Fulolosalo’o,10 Agustus 2015

Diketahui

Kepala Sekolah                                                                               Peserta

SDN No. 071029 Fulolosalo’o

FAOGODODO TELAUMBANUA                                                MASNIARI GEA

NIP. 19610412 198201 1 001