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KOMUNITAS MUSLIM (K-MUS)

FAKULTAS KEDOKTERAN GIGI


UNIVERSITAS SUMATERA UTARA
Sekretariat: Jalan Alumni No.2 kampus USU. Medan
E-mail: kmusfkgusu@gmail.com No. Telp: 085766216569

FORMULIR OPEN RECRUITMENT


PENGURUS K-MUS FKG USU PERIODE 2014-2015
Nama

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

NIM

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

Tempat/Tgl. Lahir

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

Alamat

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

Telp./Hp

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

E-mail

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

Alasan bergabung

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

dengan K-MUS

Departement
yang diminati

: 1...................................................
2...................................................
3...................................................

Organisasi

: 1. ...................................................

(yang sedang

2. ...................................................

diikuti saat ini)

3. ...................................................

(...........................................)

FB: K-mus Fkg Usu, twitter:@KMUS_FKGUSU

KOMUNITAS MUSLIM (K-MUS)


FAKULTAS KEDOKTERAN GIGI
UNIVERSITAS SUMATERA UTARA
Sekretariat: Jalan Alumni No.2 kampus USU. Medan
E-mail: kmusfkgusu@gmail.com No. Telp: 085766216569

FB: K-mus Fkg Usu, twitter:@KMUS_FKGUSU

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