BIODATA ATLET

MERPATI PUTIH UNPAD

2019

I. DATA DIRI
1. Nama : ...................................................................................................................
2. NPM : ...................................................................................................................
3. Angkatan : ...................................................................................................................
4. Fakultas : ...................................................................................................................
5. Program studi : ...................................................................................................................
6. Jenis kelamin : ...................................................................................................................
7. Tempat, tanggal lahir : ...................................................................................................................
8. Alamat rumah : ...................................................................................................................
9. Alamat kos : ...................................................................................................................
10. Golongan darah : ...................................................................................................................
11. No. handphone : ...................................................................................................................
12. Email : ...................................................................................................................
13. Line : ...................................................................................................................
14. Instagram : ...................................................................................................................
15. Berat/ tinggi badan : ...................................................................................................................
16. Riwayat penyakit : ...................................................................................................................
17. Riwayat cedera : ...................................................................................................................
18. Pengalaman beladiri : ...................................................................................................................
19. Hobi : ...................................................................................................................
II. DATA ORANG TUA/ WALI
1. Nama Lengkap : ...................................................................................................................
2. Alamat : ...................................................................................................................
3. No. Handphone : ...................................................................................................................
III. KEGIATAN EKSTRA
Organisasi Jabatan Waktu Rutin
1. ............................................................................................................................................................
2. ............................................................................................................................................................
3. ............................................................................................................................................................

Jatinangor, 2019

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