MOTOR/TAHUN : _________________________/_________________________
NO. PESERTA
NAMA PESERTA : ___________________________________________________ ( SCRUT )
BENGKEL/MODIFIKATOR : ___________________________________________________
TELP/HP : _________________________/_________________________
CUSTOM MODIFY
FASHION DAILY
LOKAL PLAT S
Bojonegoro, ………………………..2018
Peserta Panitia
(______________) (______________)
LEMBAR SPEK MODIFIKASI
SEBAGAI SYARAT PENJURIAN
HARUS DIISI LENGKAP & DIKUMPULKAN SAAT DAFTAR
NOPOL : __________________________________________________
MOTOR/TAHUN : _________________________/________________________ NO. PESERTA
( SCRUT )
NAMA PESERTA : __________________________________________________
ALAMAT LENGKAP : __________________________________________________
TELP/HP : _________________________/________________________
BENGKEL/MODIFIKATOR : __________________________________________________
ALAMAT MODIFIKATOR : __________________________________________________
TELP/HP : _________________________/________________________
INOVASI TERBARU ( Harus disebutkan detil ) ALASAN MODIFIKASI ( Harus diisi lengkap )
______________________________________________ ______________________________________________
______________________________________________ ______________________________________________
______________________________________________ ______________________________________________