Form Cagub
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Transcript of Form Cagub
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7/25/2019 Form Cagub
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KOMISI PEMILIHAN RAYA
DEWAN PERWAKILAN MAHASISWA
FAKULTAS ILMU KESEHATAN
UNIVERSITAS MUHAMMADIYAH MAGELANG
Jl. Mayjend Bambag Soegeng Km. 5 Mertoyudan Magelang 56473
FORMULIR PENDAFTARAN CALON GUBERNUR BEM FIKES UMM
PERIODE 2012-2013
Nama Lengkap : ____________________________________________________________________
NPM : ____________________________________________________________________
Jenis Kelamin : ____________________________________________________________________
Tempat Tanggal Lahir : ____________________________________________________________________
Program Studi : ____________________________________________________________________
Semester/ Tingkat : ____________________________________________________________________
No. Hp : ____________________________________________________________________
Email : ____________________________________________________________________
lamat !"umah/ Kos# : ____________________________________________________________________
Ho$i : ____________________________________________________________________
%ita&'ita : ____________________________________________________________________
Mottto H idup : ___________________________________________________________________
___________________________________________________________________Tokoh (dola : ___________________________________________________________________
Moti)asi *adi +u$ernur ,EM -(KES : __________________________________________________________________
___________________________________________________________________
___________________________________________________________________
isi : ___________________________________________________________________
__________________________________________________________________
Misi : ___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
___________________________________________________________________
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Tiga Program Ker*a 9nggulan untuk ,EM -(KES Periode 545&546:
No Nama Proker Pen*elasan
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5
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0emikian ;ormulir penda;taran ini saa isikan dengan se$enarna. Jika suatu saat nanti ditemukan kekeliruan didalamna maka saa siap menerima sanksi sesuai dengan ketentuan ang $erlaku.
Magelang< _________________________
%alon +u$ernur ,EM -(KES
__________________________________
NPM. _____________________________
Keterangan :
1#-ormulir ini 3a*i$ diisi dengan tulisan tangan11# ,oleh diperpan*ang !ditam$ahkan $aris#
N,: 0imohon untuk mengirimkan ;oto resmi hitam putih melalui email ke:dpm_;ikes=ahoo.'o.id ;oto diterima paling lam$at 6 2kto$er 545< pukul 46. >(,
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