AUTOMOTIVE SKILL COMPETITION (ASC) 2017

TINGKAT SMK SE-JAWA TENGAH

JURUSAN TEKNIK MESIN FAKULTAS TEKNIK

UNIVERSITAS NEGERI SEMARANG

2017

FORMULIR PENDAFTARAN

Yang bertandatangan dibawah ini,

Ketua Jurusan...................................................................................................................................

SMK.................................................................................................................................................

menerangkan bahwa,

Nama : ................................................................................................................

Tempat/Tanggal Lahir : ................................................................................................................

NIS : ................................................................................................................

Kelas : ................................................................................................................

Jurusan : ................................................................................................................

Sekolah : ................................................................................................................

No. Handphone : ................................................................................................................

Dengan ini menyatakan bahwa siswa tersebut benar-benar siswa SMK........................................................ Kelas....................... Jurusan.............................................

Mengetahui,

Ketua Jurusan Peserta

(.................................................) (.........................................)

NIP. NIS.

*Formulir dapat diperbanyak sendiri

FOTO PESERTA

3 X 4

(BERWARNA)