Nama : ____________________________ Kelompok : ____________________________ Tempat/Tanggal Lahir : ____________________________
foto 4x6 Agama : ____________________________
Asal : ____________________________ Hobby : ____________________________ No Hp/Id Line : ____________________________ Bidang LKM yang diminati: (pilih min. 1) BEM MPM DPM 1 HIMALOGISTA HIMATITAN HIMATETA FORKITA KMK EFRATA ARSC ABC AS TECHNO ESP SENI N Deskripsi diri (biodata singkat, kegemaran dan minat, pengalaman organisasi, prestasi yang pernah dicapai, dll dalam bentuk paragraf) ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ __________________________________________________________________________ NB : Dikumpulkan pada saat kegiatan OPEN HOUSE RAJAWALI FTP UB 2019 dimulai.