FORMULIR PT. JIAEC
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NAMA SISWA *
TEMPAT LAHIR *
TANGGAL LAHIR *
MM
/
DD
/
YYYY
ASAL SEKOLAH *
JURUSAN *
POSISI YANG DIMINATI *
TINGGI BADAN (Min. Laki-laki 163 cm, Pr 150 kg) *
BERAT BADAN (Min. Laki-laki 50 kg, Pr 43 Kg) *
TAHUN LULUS *
NO. WA/HP *
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