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FORMULIR PENDAFTARAN

ANGGOTA UKM SENI DAN BUDAYA SEMBILAN UIM


Nama lengkap
Nama panggilan

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TARI
TEATER
MUSIK AKUSTIK
MUSIK TRADISI PENGIRING TARI
PENULISAN KARYA SASTRA DAN KAJIAN BUDAYA
CINEMATOGRAPHY
Tempat/Tgl/Lahir
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Alamat
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Rumah Orang Tua/Sendiri
Kos-Kosan/Kontrakan
No.Hp/E-Mail
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Asal Univ./Sekolah/dll. : ..........................................................................................................
Fakultas : .......................................................................................
Jurusan : ......................................................................................
Angkatan : .......................................................................................
Agama
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Kota asal/suku
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Bakat
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Alasan masuk
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Minat Kesenian:

PAS FOTO 4X6


Makassar, . 201

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Sekretariat : Jln Perintis kemerdekaan Km. 9 No.29 Makassar (Kampus UIM).
Contact Person : 081243629727/085395410330 e-mail : ukmsenisembilan@gmail.com

Syarat dan Ketentuan :


1. Pendaftar membayar konstribusi pengambilan formulir sebesar 35,000 Rupiah
2. Mengembalikan Formulir Paling lambat 3 hari setelah pengambilan
3. Pengisian formulir harus JELAS dan RAPI serta dilaminating
4. Pendaftar Bersedia mengikuti Peraturan yang berlaku dalam lembaga ini.

Sekretariat : Jln Perintis kemerdekaan Km. 9 No.29 Makassar (Kampus UIM).


Contact Person : 081243629727/085395410330 e-mail : ukmsenisembilan@gmail.com

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