Formulir Pendaftaran

Calon Panitia AMBALWARSA 2019

Teknik Elektro
A. BIODATA PRIBADI Pas Foto
Nama Lengkap : .........................................................................................................
NIM : ......................................................................................................... (3x4)

Angkatan : ......................................................................................................... Berwarna

Tempat/Tanggal Lahir : .........................................................................................................
Jenis Kelamin : Laki-laki/Perempuan
Alamat Asal : .........................................................................................................
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Alamat Sekarang : ........................................................................................................................................
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Whatsapp/No Hp : ........................................................................................................................................

B. PILIHAN DIVISI

Acara Perlengkapan

KSK PDD

Konsumsi Humas

Danus Baksos

Alasan pilihan 1 :...........................................................................................................................................

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Alasan pilihan 2 :..........................................................................................................................................

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Yogyakarta, Oktober 2019

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