KATEGORI LOMBA :
.......................................................................................
NAMA SEKOLAH : ......................................................................................
ALAMAT SEKOLAH : ......................................................................................
No. TELEPON SEKOLAH : ......................................................................................
CONTACT PERSON : ......................................................................................
NO. TELEPON/HP : ......................................................................................
, 2010
Mengetahui, Penerima,
Kepala Sekolah/ Pimpinan Lembaga Panitia Lomba
() (.)
Tanda tangan, nama jelas dan stempel
Perguruan Tinggi
Sekolah : ................................................................................................
Alamat : ...............................................................................................
Telepon : ................................................................................................
Nama : ...............................................................................................
Nama2 : ................................................................................................
Nama3 : ...............................................................................................
, 2010
Mengetahui, Penerima,
Kepala Sekolah/ Pimpinan Lembaga Panitia Lomba
() (.)
Tanda tangan, nama jelas dan stempel
Catatan:
1. Formulir ini dapat difotocopy
2. *) coret yang tidak perlu
3. Bukti transfer/kuitansi harap dibawa saat registrasi
4. Pendaftaran melalui bank dapat ditransfer ke rekening:
(nama mahasiswa) BCA
Pamulang Indah
No. Rek.123-1254100
kemudian bukti transfer dan formulir pendaftaran di fax ke : 021-1234567
u.p. (nama mahasiswa)