FORMULIR PENDAFTARAN GADJAH MADA SWIMMING COMPET

YOGYAKARTA, 9 September 2

UNIVERSITAS : Institut Teknologi Bandung

Alamat : Sekretariat Olahraga Saraga no. 20
No Telpon :-

Contact Person : Thalia Nurul Herisnawati / 081324099189

Jenis Gaya Bebas Gaya Kupu-Kupu Gaya Punggung

No Nama Kelamin Tanggal Lahir
(PA/PI)
50 100 200 50 100 50 100
1 Elmo Refindra PA 11/12/1997 99.99.99 99.99.99
2 Muhammad Riezar Satria PA 12/23/1997 99.99.99 99.99.99
3 Alvin Reynaldo PA 11/16/1998 99.99.99 99.99.99
4 Eko Prayogo Goenfi PA 10/24/1998 99.99.99
5 Andrew PA 11/13/1997 99.99.99
6 I Putu Arya Aditya Nugraha PA 5/26/1997
7 Rika Permata Sari Purba PI 10/14/1999 99.99.99 99.99.99 99.99.99 99.99.99
8 Aditya Rifanda Hendrawan PA 8/23/1998 99.99.99
9 Joey Kosasih PA 7/4/1998 99.99.99
10 Andrey PA 11/13/1997 99.99.99
11 Nicholaus Kevin Tanjaya S. PA 6/21/1996

ganti benedichto??????
UNIVERSITAS :
Alamat :
No Telpon :

Contact Person : Form Sparing Part

No Nama Gaya Bebas Gaya Kupu-Kupu Gaya Punggung Gaya Dada

50 100 200 50 100 50 100 50 100

MMING COMPETITION 2017
A, 9 September 2017

Form Perenang

Estafet

Gaya Gaya
Gaya Dada Gaya Ganti Bebas Ganti

50 100 200 200 4x50 4x50

99.99.99
99.99.99 99.99.99 99.99.99
99.99.99 99.99.99
99.99.99
99.99.99 99.99.99 99.99.99
99.99.99 99.99.99 99.99.99

99.99.99 99.99.99 99.99.99

99.99.99 99.99.99 99.99.99
99.99.99
99.99.99 99.99.99
 Form Sparing Partner (SP)

Gaya Dada Gaya Ganti

200 200
 FORMULIR PENDAFTARAN GADJAH MAD
YOGYA

UNIVERSITAS : Gadjah Mada

Alamat : BULAKSUMUR, D.I. YOGYAKARTA 55281
No Telpon : 082225325143/089627427488

Contact Person : 089627427488

Jenis Gaya Bebas

No Nama Kelamin Tanggal Lahir
(PA/PI)
50 100 200
1 REYNA AFIFAH BACHRI PI 4/24/1995 00.39.00
2 SIDIK TRI WIBOWO PA 2/8/1994

UNIVERSITAS :
Alamat :
No Telpon :

Contact Person :

No Nama Gaya Bebas Gaya Kupu-Kupu

50 100 200 50 100

GADJAH MADA SWIMMING COMPETITION 2017
YOGYAKARTA, 9 September 2017

Form Perenang

Estafet

Gaya
Gaya Kupu-Kupu Gaya Punggung Gaya Dada Gaya Ganti
Bebas

50 100 50 100 50 100 200 200 4x50

00.43.00 00.43.00
99.99.99 99.99.99

Form Sparing Partner (SP)

Gaya Punggung Gaya Dada Gaya Ganti

50 100 50 100 200 200

Estafet

Gaya
Ganti

4x50