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FORM REGISTRASI DOMAIN DAN HOSTING ITB

Nama Domain* Nama Organisasi pemohon Nama Penanggung Ja a! * NIP"NI# $e!%A&min 'A&minis(ra(or) Nama NIM"NIP"NI# E%mai* No Te*ephone A*ama( Masa A+(i, ** : : : :

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Penanggung -a a! . a&a*ah piha+ /ang !er(anggung -a a! a(as &omain (erse!u(. Penanggung -a a! un(u+ &omain himpunan &an e0en( -urusan a&a*ah #asu!ag SI &ari ,a+u*(as" -urusan * Penanggung -a a! un(u+ &omain uni( mahasis a a&a*ah &osen penanggung -a a! uni( (erse!u(
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Nama &omain Nama uni( +egia(an mahasis a &i(u*is &i&epan 1uni(1i(!1a21i& Nama himpunan mahasis a &i(u*is &i&epan 11'pro&i)1i(!1a21i& Nama *a! " +e*ompo+ +eah*ian &i(u*is &i&epan 1'pro&i)1i(!1a21i& a(au 1',a+u*(as)1i(!1a21i& Nama +egia(an " +epani(iaan &i(u*is &i&epan nama uni("pro&i"*a!"*em!aga /ang menaungi +epani(iaan " +egia(an (erse!u(
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Masa a+(i, ma+simum /ang &ii-in+an un(u+ &omain himpunan a(au uni( mahasis a a&a*ah 3 !u*an. se(e*ah 3 !u*an harap menghu!ungi +em!a*i a&minis(ra(or un(u+ perpan-angan &omain &an hos(ing Dengan mengirim+an emai* +e hos(ing4i(!1a21i& 22 i(%he*p&es+4i(!1a21i& &engan su!-e2( emai* 5Perpan-angan &omain &an hos(ing ITB6

Dengan menan&a(angani Form ini piha+ penanggung -a a! (e*ah men/e(u-ui nama &omain /ang &imin(a &an (u-uan &ari &i!ua(n/a &omain &an hos(ing (erse!u( &ia(as. &an -uga (e*ah mem!a2a pera(uran &an men/e(u-ui pera(uran mengenai &omain &an hos(ing /ang (er(era pa&a h((ps:""ni21i(!1a21i&"2a+e"po*i2/"0ie "7

Penanggung Ja a! Domain &an hos(ing

A&minis(ra(or

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