FORMULIR PENDAFTARAN

DIKLAT AKTING & PENULISAN SKENARIO

AKSINEAS ACTING & FILM SCHOOL

Nama Lengkap             : ..............................................................................................

Tempat/Tgl.Lahir          :  ..............................................................................................

Pendidikan Terakhir      : ..............................................................................................

Pekerjaan                    :  ..............................................................................................

Nama Orangtua           :  ..............................................................................................

Tinggi/Berat Badan      :...........Cm/............Kg 

UkuranBaju/Sepatu      :.............  / ..............

Pilihan Diklat                : a. Akting         b. Penulisan Skenario Film

Alamat rumah              : ..............................................................................................

                                   ..............................................................................................

                                  Telp. …...........……………………. Hp. …......…...............…………………………

Email/FaceBook            : ..............................................................................................

Pin BB/WA                   :  ..............................................................................................

Pengalaman Akting/Seni :  ..............................................................................................
                                    ...............................................................................................
                                     ..............................................................................................

Jakarta, ......................2016
Pendaftar,

                                        _________________________

                                      Tanda tangan & nama lengkap


*Lampirkan 2 lbr pasfoto ukuran 4x6 & biaya diklat sebesar Rp. 3,5 juta.
*kirimkan via email ke This email address is being protected from spambots. You need JavaScript enabled to view it. atau diprint, diisi & dibawa waktu
 mendaftar ke studio Aksineas.