Friday, 29 April 2011

Borang Keahlian Gerakan Alumni Sebentok

                                                                                                                               


                                                                                                                            
                                                              

GERAKAN ALUMNI SEBENTOK
SEKOLAH MENENGAH KEBANGSAAN BUKIT MENTOK
24000 KEMAMAN
TERENGGANU DARUL IMAN
alumnisebentok@yahoo.com

BORANG KEAHLIAN GERAKAN ALUMNI SEBENTOK

MALUMAT PERIBADI                                                                                                                     
Nama Ahli: ____________________________________      Tempat Lahir :___________
Tarikh Lahir :______________________________________  Jantina : M/F                     
Kad Pengenalan :___________________________________  Email :_________________
Warganegara:______________________________________  Bangsa:________________
Agama: ___________________________________________  Status:_________________
Pekerjaan:_________________________________________  Umur:_________________
Alamat Rumah :_____________________________________  Tel Bimbit :_____________
                                _____________________________________
                                _____________________________________

Alamat Pejabat :_____________________________________       Tel. Pejabat :____________
                                ______________________________________
                                ______________________________________                          

Alamat Surat Menyurat:__________________________________________
                                                __________________________________________
                                              ____________________________________________



MAKLUMAT PASANGAN(PILIHAN)
Taraf Perkahwinan :______________________________________________
Bilangan Anak :__________________________________________________                           
Nama Isteri/Suami :______________________________________________            
Tel Rumah:_______________________________________________                                           
Umur Isteri/Suami  :___________________________________
Asal Isteri/Suami :_____________________________________        
Pekerjaan Isteri/Suami : ______________________________
No.Tel Isteri/Suami :_______________________________________              
Email Isteri/Suami :__________________________________________
                                                                                                                                               
                                                                                                                                                                               
MAKLUMAT KELUARGA                                                                                                                               
Nama Bapa/Penjaga:                                                                           Pekerjaan Bapa :
Nama Ibu/Penjaga:                                                                              Pekerjaan Ibu :
Bilangan Adik Beradik :                                                                       Anak Yang Ke :                                                                                 
MAKLUMAT AKADEMIK
Maklumat Sekolah Terdahulu:
Nama
Tahun
Keputusan


















                                                                               
Tahun Akhir Bersekolah:
Kelas Terakhir:
                                                               
                                                                                                                               
                                                               
                                                                                                                               
PENGAKUAN
                                                                                                                               
Saya mengaku maklumat yang diberikan adalah benar dan akan mengikuti setiap aktiviti dan program  dengan tulus dan setiahati                                                                              
Sekiranya saya diterima menjadi ahli GAS, saya berjanji akan mematuhi perlembagaan pertubuhan ini.                                                                 

Nama : 
Tandatangan                                                                                                                     

________________________
Tarikh :                                                                                                                
                                                                                                                               
                                                               




UNTUK TINDAKAN J/KUASA URUSETIA :                                                              
                Tarikh Permohonan Diterima:                                                   
                                                                No.Keahlian(Baru):                                         Masa :  
                                                                Diterima Oleh :                                                 



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