Formulir pendaftaran keanggotaan pengkot PBSI Jakut

Nama perkumpulan/PB           : SAXON PRIMA
Alamat sekretariat                   : Jl. Bugis Raya no. 87 A
                                                Tanjung Priok
No. telp/fax                             : 081317128505 , 082123523897
Tempat latihan                         : GOR Aulia
Jadwal latihan                          :Hari  :                                           Jam :
                                                  Selasa                                            16.00 - 20.00
                                                  Rabu                                              08.00 - 10.00
                                                  Sabtu                                             16.00 - 20.00
                                                  Minggu                                          14.00 - 18.00
Ketua                                     : Donald Mowoka
Ketua I                                   : Muhammad Romlan
Sekretaris                               : Dwi Retnoningsih, SE
Bendahara                              : Sugiyarti
Sie. Umum                             : Nenden Rahmadiah
Pelatih                                    : Sri Ayu
Jumlah Pemain Putra               : 9 orang
                                                 * Joshua (usia dini)
                                                 * Rey (anak-anak)
                                                 * Joy (anak-anak)
                                                 * Ganang (usia dini)
                                                 * Arifin (remaja)
                                                 * Iqbal (remaja)
                                                 * Dera (anak-anak)
                                                 * Ryandi (remaja)
Jumlah Pemain Putri                : 6 orang
                                                 * Chaterine P (anak-anak)
                                                 * Deby (anak-anak)
                                                 * Tasya (remaja)
                                                 * Gaby Natalia (anak-anak)
                                                 * Nissa Nurhasanah (remaja)
                                                 * Alida Carlin (remaja)



                        Jakarta,                                                           
                        Ketua PB                                                           Sekretaris




                ( Donald Mowoka)                                           (Dwi Retnoningsih,SE.)