Hadiah Sayembara

CERPEN*

Hadiah Sayembara
CERBER*

Pemenang I: Rp6.000.000
Pemenang II: Rp4.000.000
Pemenang III: Rp3.000.000

Pemenang I: Rp15.000.000
Pemenang II: Rp9.000.000
Pemenang III: Rp7.000.000

*) Hadiah dikenakan pajak 5% (dengan NPWP) atau 6% (tanpa NPWP).

Formulir Sayembara Mengarang Cerpen & Cerber Femina 2012
Nama

: ................................................................................................................................................

Tempat/Tanggal Lahir

: ................................................................................................................................................

Alamat Rumah

: ................................................................................................................................................

Kode pos

: ................................................................................................................................................

Telepon Rumah

: ............................................................................ HP:.............................................................

Pekerjaan

: ................................................................................................................................................

Alamat Kantor

: ................................................................................................................................................

................................................................................................................................................

................................................................................................................................................

Kode pos

: ................................................................................................................................................

Telepon kantor

: ................................................................................................................................................

E-mai

: ................................................................................................................................................

Karya yang pernah dipublikasikan

: ................................................................................................................................................

................................................................................................................................................

................................................................................................................................................

Karya yang pernah mendapat penghargaan : ................................................................................................................................................

................................................................................................................................................

................................................................................................................................................

Anda juga bisa mengunduh formulir ini di www.femina.co.id

PERNYATAAN KEASLIAN KARYA
Saya yang bertanda tangan di bawah ini:
Nama

: ................................................................................................................................................

Alamat

: ................................................................................................................................................

Alamat surat

: ................................................................................................................................................

No. identitas (KTP/SIM)

: ................................................................................................................................................

Dengan ini menyatakan bahwa cerpen/cerber yang saya ikut sertakan dalam Sayembara Cerpen & Cerber Femina 2013 berjudul:
1) ..………………………………………………………………………………........…………………………………………………………………………
2) ..……………………………………………………………………………………........……………………………………………………………………
merupakan hasil karya saya sendiri, serta bukan terjemahan, dan belum pernah dipublikasikan secara keseluruhan maupun sebagian,
di media cetak, elektronik, maupun online.
Saya bersedia menanggung segala tuntutan, jika di kemudian hari ada pihak yang merasa dirugikan, baik secara pribadi maupun
tuntutan secara hukum.
Demikian pernyataan ini saya tulis dengan jujur dan penuh tanggung jawab.
..…………….. ,…………….. 2012
Hormat saya,

Materai Rp 6.000

(..…..…………………)

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