FORMULIR

DEBAT
“DEKAN CUP FISIP UMB”
URGENSI PENGESAHAN RUU PKS

Sekretariat Panitia

Kampus IV Universitas Muhammadiyah Bengkulu

 FORMULIR PENDAFTARAN

LOMBA DEBAT DEKAN CUP FISIP UMB TAHUN 2019

“URGENSI PENGESAHAN RENCANA UNDANG-UNDANG PENGHAPUSAN KEKERASAN SEKSUAL”

NAMA SEKOLAH : .............................................................................................

NAMA PENDAMPING : .............................................................................................

NAMA PESERTA :

Nama Ketua : .............................................................

NIS : .............................................................

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

Photo
Alamat : .............................................................

No Hp : .............................................................

Email : .............................................................

Nama Anggota 1 : .............................................................

NIS : .............................................................

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

Alamat : .............................................................

No Hp : .............................................................

Email : .............................................................

Nama Anggota 2 : .............................................................

NIS : .............................................................

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

Alamat : .............................................................

No Hp : .............................................................

Email : .............................................................

Bengkulu, Oktober 2016

Hormat Kami,
Ketua Tim

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