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Bambang Warsita
Bid. Pengembangan Jejaring
Pelatihan Penataan Jejaring Kantor untuk
e-Administrasi dan Pemanfaatan Server
Konten

BIODATA PESERTA

Surakarta,
Surakarta, 13 s.d 15 Oktober 2011

1. NAMA PESERTA
: ..........................................................................
2. TEMPAT / TGL LAHIR
: ..........................................................................
3. AGAMA

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

4. JENIS KELAMIN

: LAKI-LAKI/ PEREMPUAN* (coret yang tidak

perlu)
5. NIP
: ..........................................................................
6. NPWP

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

7. PANGKAT / GOLONGAN
: ..........................................................................
8. JABATAN
: ..........................................................................
9. NAMA INSTANSI

: ..........................................................................
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10. ALAMAT KANTOR/INSTANSI


: ..........................................................................
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TELPON
: ..........................................................................
Fax

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

E- MAIL

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

11. ALAMAT RUMAH

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

TELPON

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

HP

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

E- MAIL

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

Surakarta, ................................ 2011

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NIP.
Catatan:
Mohon diisi dengan huruf cetak dan dikirim ke panitia
(fax. 021-7401727 atau email: bambang.warsita@kemdiknas.go.id)