PEMERINTAH KABUPATEN OGAN KOMERING ILIR

DINAS KESEHATAN
Jalan Letnan Muchtar Saleh No. 85 Kayuagung, 30611
Telp/Fax (0712) 321300 Email : dinkesoki@yahoo.co.id Website :dinkes.kaboki.go.id

BIODATA PESERTA
PERTEMUAN PENGELOLA PROGRAM SURVEILANS
DALAM PENANGANAN COVID-19
DINAS KESEHATAN KAB. OKI TAHUN 2021
(HOTEL CIPTA, 27-29 MEI 2021)

NAMA LENGKAP : .........................................................................................

NIP : .........................................................................................

TEMPAT / TGL LAHIR : .........................................................................................

PANGKAT/GOLONGAN : .........................................................................................

JABATAN : .........................................................................................

INSTANSI/KANTOR : .........................................................................................

ALAMAT KANTOR : .........................................................................................

ALAMAT RUMAH : .........................................................................................

Telp / HP : .........................................................................................

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

PENDIDIKAN TERAKHIR : ........................................................................................

Kayuagung, 27 Mei 2021

Yang Bersangkutan,

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