PANITIA LOMBA KARYA TULIS ILMIAH (LKTI) TINGKAT SMA/SMK

TAHUN 2012 DI KABUPATEN MUSI BANYUASIN

Sekretariat : Universitas Sriwijaya
Jl. Lintas Sumatera, Indralaya. Ogan Ilir Sumatera Selatan. Contact Person; Dr, Alfitri ,M.Si
(0812-7822895) dan Dr. Iskhaq Iskandar, (0821-79586528)
FORMULIR PENDAFTARAN
PESERTA INDIVIDU LOMBA LKTI TINGKAT SMA TAHUN 2012
DI RING 1 CONOCOPHILLIPS INDONESIA KABUPATEN MUSI BANYUASIN

1. Nama

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2. Umur

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3. Jenis Kelamin

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4. Tempat Tanggal Lahir

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5. Alamat

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6. No Handphone/Telp

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7. Asal sekolah

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8. Kelas/Jurusan

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9. Judul Penelitian

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10.Guru Pembimbing

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11.Minat Bidang Pengetahuan : ......................................................................

12.Harapan Mengikuti Lomba

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13.Prestasi

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a) .................................................................
b) .................................................................
c) .................................................................
d) .................................................................

14.Hobi

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.............,......,November 2012