Form Pendaftaran Lkti Pertamina
Form Pendaftaran Lkti Pertamina
SPP.PWK
HUT PERTAMINA KE 59
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DATA PESERTA
1. Ketua
Nama Lengkap
Nomor Induk Mahasiswa
Jurusan/Fakultas/Angkatan
Alamat Rumah
Telepon/HP
Email
2. Anggota 1
Nama Lengkap
Nomor Induk Mahasiswa
Jurusan/Fakultas/Angkatan
Alamat Rumah
Telepon/HP
Email
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Foto
3x4
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Foto
3x4
PERTAMINA
FSPPB
SPP.PWK
HUT PERTAMINA KE 59
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Foto
3x4
Dengan ini saya menyatakan keikutsertaan diri/tim kami pada acara Part Of Society HUT
Pertamina yang ke-59 dalam Lomba Karya Tulis Ilmiah (LKTI), serta akan mengikuti prosedur
kompetisi yang ada.
.................,.................................2016
Tanda Tangan,
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(Nama Lengkap Ketua Tim)
PERTAMINA