SEKOLAH MENENGAH ATAS NEGERI 3 KEDIRI

ORGANISASI SISWA INTRA SEKOLAH (OSIS)

SIE KOMUNIKASI DALAM BAHASA INGGRIS
Jalan Mauni Nomor 88 Kota Kediri Telpon 0354-683809, Fax (0354) 683809 Kode Pos 64131
e-mail: sman3kdr@sman3kediri.sch.id website : www.sman3kediri.sch.id

ENGLISH CLUB
REGISTRATION FORM
Personal

Name :
Class :
Date of Birth :
Address :
SMP / MTs :
Hobby :
English Skill :
Phone :
Email :
Extracurricular / Organization :
Motivation to Join the English Club⬇

Parents
Father’s Name :
Address :
Phone :

Mother’s Name :
Address :
Phone :
Answer the question below honestly!
Do your parents agree to you joining this communitiy? What is the reason?

Photo
3×4

Parent’s Sign Registrar’s Sign

Nb : - Fill the form honestly.

-Take the picture using uniform with plain background.
-Sign it on a paper and then take a picture of it. After that copy paste in this form.