Formulir Pendaftaran Offline Lomba Esai Sinaps 2015
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KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGI UNIVERSITAS JEMBER FAKULTAS KEDOKTERAN BADAN EKSEKUTIF MAHASISWA Jalan Kalimantan 37 Kampus Telgal Boto Telp/Fax. (0331) 337877 Jember 68121 E-mail : [email protected] FORMULIR PENDAFTARAN OFFLINE LOMBA ESAI SINAPS 2015 Nomor Pendaftaran : ............... Judul Esai * : ............................................... .......................................................... Nama Peserta : ............................................... .......................................................... Tempat, Tanggal Lahir : ............................................... .......................................................... Asal Sekolah : ............................................... .......................................................... Alamat Sekolah : ............................................... .......................................................... No.HP : ......................................... ................................................................ e-Mail : ............................................... .......................................................... Kelengkapan Pendaftaran * : Formulir Pendaftaran Foto berwarna 3x4 Fotokopi Kartu Pelajar Uang Pendaftaran
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Transcript of Formulir Pendaftaran Offline Lomba Esai Sinaps 2015
KEMENTERIAN RISET, TEKNOLOGI, DAN PENDIDIKAN TINGGIUNIVERSITAS JEMBER
FAKULTAS KEDOKTERANBADAN EKSEKUTIF MAHASISWA
Jalan Kalimantan 37 Kampus Telgal Boto Telp/Fax. (0331) 337877Jember 68121 E-mail : [email protected]
FORMULIR PENDAFTARAN OFFLINE LOMBA ESAI SINAPS 2015
Nomor Pendaftaran : ...............
Judul Esai* : .........................................................................................................
Nama Peserta : .........................................................................................................
Tempat, Tanggal Lahir : .........................................................................................................
Asal Sekolah : .........................................................................................................
Alamat Sekolah : .........................................................................................................
No.HP : .........................................................................................................
e-Mail : .........................................................................................................
Kelengkapan Pendaftaran* : Formulir Pendaftaran Foto berwarna 3x4
Fotokopi Kartu Pelajar Uang Pendaftaran
Cara Pendaftaran Offline* : Kolektif
Individu
............, ................................... 2015
Peserta
( )
*Tidak wajib diisi. Karya dikirimkan ke [email protected] sesuai ketentuan.
NB: Periksa kembali dengan teliti. Panitia tidak bertanggung jawab atas kesalahan penulisan.
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