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c

c
c

ccccFORMULIR

PENDAFTARAN PESERTA GEOSPACE 2010

FAKULTAS GEOGRAFI UNIVERSITAS GADJAH MADA


c

c
cccc

Nama Lengkap / Panggilan : ___

c

Jurusan /Program Studic

c
cccccc

Tempat/Tanggal Lahircc
Alamat Asalc

c

cc

c
cccc

c
c

Alamat Sekarang:cc
c

ccccc

c


CP yang bisa dihubungi :c


Asal Sekolahc

c

Status Mahasiswaccccccccc
cccc cc
Agamac

c

Hobi c

c

c
c

Prestasi yg pernah diraih :c

cc

cc

Kemampuan Bahasa Asing :


c  cc

c c"# cc

c c cc

c c"$cc

!c cc c

c %c

Penyakit yg sedang/ pernah diderita : _______________________________________________


________________________________________________________Gol.darah: A / B / AB / O
Alergi makanan

: ___________________________________________________________

$c&  c Ayah/Ibu c

cc

c

c

$c

c

cccc

cc

ccc'''''' ''''' c


(c c# c)  c% c #c    cc c c% c  c c c c*) %c
Nama Walic

c

+   c

c

$c

c

cc

cccc

Tandai organisasi/kegiatan yang pernah diikuti sewaktu SMA


c,-.c

c&  c

!c,&+ c

c,c

c.,c c

 .,c

c) c
cc c

c! c c

cc c

Bacaan (buku/novel/majalah/koran) yang pernah saya baca:


c  
c

c$cccccc

!c )c+)c/c c

c.  c,%c c

c,# c

cc

c 
c

c 0c

c) )!!cc

c c/c)0c)c)c

c/ c c

cc%cc

c

c c
c


T i 

cc
c c

c  c

c   
c

c
 cc

c  c

c   c

c   c

c,  c
c c

 i 
  i i
c
c


c c

c,
,
c cccccccccc c   
cc

c   c


i     i  i/ i   i   il   i
c  c
c    c

c  c

c c,  c

c  c c  c

c 
 c

c  c c

c  ! c

  
    i  i
c"c
  c   c c c c   c   c   c  c c
!c
cc  c
#c c c  c c
 c c
c c  #c  c  c c
  c
c c  c c
  c   c 
  c  c  c    c c  c
c  c$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$cccc

  iili cccc$$$$$$c


l    ic

c$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$c

   icc$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$c

Tli    i   


    i     i c c  c c  c #c  c  c c
  c   !c
%c   c&  cc

%1c     c c/
cc

'c c  ccc

%%c  c/cc

(c  cc

cccc

%'c  c2  cc

)c  
c    ccc

%(c , 
c
cc

*c +
 c ccc

%)c  c3 cc

,c 
 ccccc

%*c 4c,  cc

-c 
ccc

%,c   c 


cc

.c   c/

ccc

%-c a c  c+ ccc

0c  c  cc

%.c c   c  cc


c

Bi     i  i i ii i



%c
'c
(c

 c   c c  ccc   c


  c  !c
 #c  cc c/c
)c Y Y  c  c    c
  #c  #cc   c
*c    c`c"  c

 #c   #c c    c   c
,c cc c,   cc
c
5
cc  c c  c    c c    c   c c c   c  c   c   c
  c'1%1c
c

c
c
   #cc
cccccccc+
   #c$$$$$$$$$$$$$$$$$$c'1%1c
c
  cc
  c
c
cccccccccc (c6c)c
c
c
c

$$$$$$$$$$$$$$$$$cc
cc

$$$$$$$$$$$$$$$$$c

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