FORMULIR PENDAFTARAN FIM IC 4 TH 2020
1. Nama Lengkap *
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2. NISN *
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3. Tempat Lahir *
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4. Tanggal Lahir *
MM
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DD
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YYYY
5. Jenis Kelamin *
6. Alamat Peserta *
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7. Jenjang Madrasah/Sekolah *
8. Asal Madrasah/Sekolah *
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9. Alamat Madrasah/Sekolah *
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10. Kabupaten/Kota *
11. No. Telepon/Handphone *
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12. Email *
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13. Bidang Lomba yang diikuti *
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