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DEWAN PERWAKILAN MAHASISWA KBMK UNSOED 2013

FORMULIR PENDAFTARAN

PANITIA PEMILU CALON PRESIDEN TERPILIH

Nama Lengkap : .........................................................................................................................

NIM : .........................................................................................................................

Angkatan : .........................................................................................................................

Tempat, Tanggal Lahir : .........................................................................................................................

Alamat Kos : .........................................................................................................................

Nomer HP : .........................................................................................................................

Riwayat Organisasi : .........................................................................................................................

Riwayat Kepanitiaan : .........................................................................................................................

Divisi yang diminati :

*) Pilihan Pertama

1. Sekretaris 5. Konsumsi
2. Bendahara 6. D3
3. Acara 7. Perlengkapan
4. Humas
Alasan : .........................................................................................................................

..................................................................................................................................................................

*) Pilihan Kedua

1. Sekretaris 5. Konsumsi
2. Bendahara 6. D3
3. Acara 7. Perlangkapan
4. Humas
Alasan : .........................................................................................................................

..................................................................................................................................................................

Purwokerto, September 2013

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*) Lingkari pada salah satu divisi yang diminati.

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