PENDAFTARAN PESERTA DIDIK BARU
PKBM NUSA MANDIRI
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Nama Lengkap (bukan Sebutan)
Nomor HP/ WA
Jenis Pendaftaran
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NIS (jika memiliki)
Asal Sekolah sebelumnya
 No. Seri Ijazah (bagi pendaftar paket B dan Paket C)
Pilihan lokasi Belajar
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