FORMULIR PENDAFTARAN LOMBA KARYA TULIS ILMIAH MAHASISWA TINGKAT NASIONALNATIONAL AVICENA COMPETITION 2015Asal Universitas : ...............................................................................Nama lengkap : ...............................................................................Jenis kel. : L/P (*)Alamat : ...............................................................................Tempat/ Tanggal lahir : No. telp/ Hp : ...............................................................................Prestasi : ...............................................................................................................................................................................................................................................................................................................................Konsmsi : !egetarian / Non !egetarian (*)Keterangan: (*) : "oret #ang ti$ak perl %asing&masing peserta mengisi 'ormlir #ang (er(e$a. )ormlir ini $apat $iper(an#ak sesai ke(than. Pengmplan 'ormlir $isertai $engan * lem(ar 'otokopi kart mahasis+a $an * (ah 'oto (erkran ,-. ('oto lain selain ntk $itempel). Penlisan 'ormlir menggnakan hr' kapital.)oto, / .