FORMULIR PENDAFTARAN

PENGURUS HIMPUNAN MAHASISWA JURUSAN MANAJEMEN

A. Data Pribadi

Nama : ...................................................................................................................................

NIM : ...................................................................................................................................

Semester : ...................................................................................................................................

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

Alamat Asal : ...................................................................................................................................

Alamat di Malang : ...................................................................................................................................

Telepon : ...................................................................................................................................

e-mail : ...................................................................................................................................

B. Riwayat Pendidikan

Jenjang
Nama Sekolah Alamat Sekolah Tahun Lulus Keterangan
Pendidikan
SD

SMP

SMU

C. Pengalaman Organisasi

No. Nama Organisasi Jabatan Tahun Menjabat Keterangan

Motto : ......................................................................................................................................................

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

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

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Malang, ........................................2010.

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