1. Nama :…………………………
2. Fakultas :…………………………
3. Jurusan :........................................
4. Semester :........................................
5. Jenis Kelamin :…………………………
6. Umur :…………………………
7. Alamat :........................................
Tim Penyusun :
Dzul Azmah Nasution (091501068)
Liska Rambe (091501137)
Ovalina Sylvia Br. Ginting (091501092)