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PANITIA PELAKSANA

PELATIHAN KADER DASAR (PKD) 2019


PERGERAKAN MAHASISWA ISLAM INDONESIA
(Indonesian Moslem Student Movement)
RAYON DAKWAH & KOMUNIKASI
KOMISARIAT UIN SUNAN AMPEL SURABAYA
Kantor : Jl. Ahmad Yani No. 117 Surabaya
Telp. 081249708175

Formulir Pendaftaran
Nama Lengkap : .............................................................................

NIM : .............................................................................
3x4
TTL : .............................................................................

Alamat Asal : .............................................................................

Alamat Domisili : .............................................................................

No HP (WA) : .............................................................................

Prodi/Kelas/Smester : .............................................................................

Motto Hidup : .............................................................................


Pengalaman Ikut Organisasi
1. ...............................................................................................................................

2. ...............................................................................................................................
Bakat dan Minat
1. KEILMUAN
2. JURNALISTIK
3. OLAHRAGA
4. KESENIAN
5. LAIN LAIN ........................................................................................
Ceklis yang berhubungan dengan minat dan bakat.
Motivasi Mengikuti

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Dengan ini saya bersedia mengikuti PELATIHAN KADER DASAR PMII RAYON
DAKWAH & KOMUNIKASI TAHUN 2019.
Pendaftar

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