Post on 04-Jan-2016
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Kursus EKG (Elektrokardiogram)FAKULTAS KEDOKTERAN
UNIVERSITAS JENDERAL ACHMAD YANI
FORMULIR PENDAFTARAN
Tanggal Pelatihan : 23 Juli 2015
Tempat Pelatihan : Gd Student Centre (samping Lab Biokim FK universitas jenderal achmad yani)
* Identitas
Nama sesuai identitas : Wendy Sadikin..........................................................................................................................................................
Kewarganegaraan :Indonesia ..........................................................................................................................................................
Jenis kelamin : Laki-Laki............................................................................................................................................................
Tempat lahir : .Bandung...........................................................................................................................................................
Tanggal lahir :05-September-1988 ............................................................................................................................................................
Alamat Tinggal : Jl. Setiabudhi No.116............................................................................................................................................................ .............................................................................................................................................................
Kota : .Bandung..........................................................................................................................................................
Email :wendysadikin@gmail.com .....................................................................................................................................................
Telepon : 022-2042280..........................................................................................................................................................
Telepon Seluler : 0816616988............................................................................................................................................................
Alamat Tempat Kerja : Jl. RE Martadinata No.135................................................................................................................................................. .............................................................................................................................................................
Nama Rumah Sakit/Instansi : Lab Klinik Pramita.............................................................................................................................................................
Alamat Rumah Sakit/Instansi : Jl. RE Martadinata No.135....................................................................................................................................................
.............................................................................................................................................................
Kota : Bandung.............................................................................................................................................................
Telepon / Fax : 022-7271946.............................................................................................................................................................
* Identitas Pendidikan
Universitas / Institusi : Universitas Kristen Maranatha.........................................................
Fakultas : Fakultas Kedokteran.........................................................
Tahun Masuk / Tahun Lulus :2007-2012 ..........................................................
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