12/8/2014
http://booking.gedepangrango.org/booking.php 1/1
DRAFTPENDAFTARANPENDAKIANGUNUNGGEDEPANGRANGO
(draftiniharusditukardenganSIMAKSIyangtelahdisahkanolehpejabatyangberwenang)
Datatelahdivalidasi,dantelahdinyatakanVALID
NamaKetuaKelompok: WisnuSambojo NamaOrganisasi: Jayagiri
TanggalLahir: 03Desember201423:19:11 AlamatOrganisasi:
jl.kebonkopiRT007/004tangerangselatan
JenisKelamin: KetuaKelompok TeleponOrganisasi: 081298336110
Pekerjaan: WisnuSambojo NomorKartuIdentitas: 25/04/1992
TujuanPendakian: GunungGede/Pangrango
JenisKartuIdentitas: Pria PintuMasuk:
GunungPutriBerlakuSampaiDengan: karyawanswasta PintuKeluar:
Cibodas
AlamatRumah: 3674032503920012 TanggalMasuk: 26Desember2014Kota:
KTP JamMasuk: 06.0011.00TeleponRumah: 25/04/2017 TanggalKeluar:
27Desember2014
Handphone: jl.kebonkopiRT007/004pondokbetungpondokaren
JamKeluar: 16.0021.00
AlamatEmail: tangerang
Daftaranggotayangakanikutpendakian
No. Nama TanggalLahirJenis
Kelamin
KartuIdentitas/BerlakuSampai
DenganTeleponRumah Pekerjaan
1 naninulfah 01/11/1994 Wanita KTP01/11/2017 mahasiswi
2 ariniyulianaagustine 07/11/1995 Wanita KTP07/11/2017
mahasiswi
3 SofiAprilianti 09/04/1995 Wanita KTP09/04/2018 0254570809
Mahasiswi
4 RetnoWidiati 03/09/1994 Wanita KTP03/09/2016 087726023909
mahasiswi
5 andirosa 16/03/1990 Pria KTP16/03/2016 mahasiswa
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