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PANITIA PEKAN REMAJA TEGAR PIKMA-SRIWIJAYA PUSAT INFORMASI DAN KONSELING MAHASISWA SRIWIJAYA

( PIKMA-SRIWIJAYA ) UNIVERSITAS PEKALONGAN

Jl. Sriwijaya No.3, Pekalongan

CP :

Danang Prabowo (085647395969)

Yulis Indriyani (085741983529)

FORMULIR PENDAFTARAN

LOMBA POSTER PEMAGAR

KATEGORI : PELAJAR / MAHASISWA/UMUM

NAMA :........................................................................................................

TTL :.......................................................................................................

ALAMAT :......................................................................................................

JENIS KELAMIN : LAKI-LAKI/ PEREMPUAN

ASAL SEKOLAH/INSTANSI :......................................................................................................

ALAMAT SEKOLAH/INSTANSI :......................................................................................................

NO. HP :......................................................................................................

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NB : *isi dengan huruf capital

*coret yang tidak perlu.

* info lebih lanjut hubungi CP

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