FOMULIR PENDAFTARAN

Miners Zone Sport Championship

HMTP CUP 2015

Angkatan : ......................................................................................................
Nama Team : ......................................................................................................
Manager : ......................................................................................................
Contact Person : ......................................................................................................

Data Pemain
1. Nama : ......................................................................................................
Posisi : ......................................................................................................
No. Punggung : ......................................................................................................
No. Hp : ......................................................................................................

2. Nama : ......................................................................................................
Posisi : ......................................................................................................
No. Punggung : ......................................................................................................
No. Hp : ......................................................................................................

3. Nama : ......................................................................................................
Posisi : ......................................................................................................
No. Punggung : ......................................................................................................
No. Hp : ......................................................................................................

4. Nama : ......................................................................................................
Posisi : ......................................................................................................
No. Punggung : ......................................................................................................
No. Hp : ......................................................................................................

NB : 1. Fotocopy KTM 1 rangkap

2. Fotocopy KRS semester JULI DESEMBER 2015 1 rangkap
3. minimal 3 pemain/team, maksimal 4 pemain/team

Demikian formulir pendaftaran ini kami isi dengan sebenar benarnya dan dengan penuh rasa
tanggungjawab. Dengan ini kami mendaftarkan team kami untuk berpartisipasi dalam HMTP
CUP 2015 dan siap menaati segala bentuk peraturan dan ketentuan yang berlaku.
Padang, Oktober 2015

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