PANITIA PELAKSANA

PENERIMAAN ANGGOTA BARU

HIMPUNAN MAHASISWA SATARMESE RAYA
TAHUN 2021
Sekretariat: Jl. Letjen Hertasning Makassar –E-mail: himasraya20@gmail.com, CP:081338288379/085345886839

FORMULIR PENDAFTARAN

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

TTL : .........................................................................................................
NO. HP / WA : .........................................................................................................
ALAMAT : .........................................................................................................
ASAL KAMPUS : .........................................................................................................
JURUSAN : .........................................................................................................
TAHUN MASUK KAMPUS : .........................................................................................................
PENGALAMAN ORGANISASI
1. .............................................................................................................................
2. .............................................................................................................................
3. .............................................................................................................................
4. .............................................................................................................................
5. .............................................................................................................................
MOTIVASI MASUK HIMAS RAYA
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Makassar,....Januari 2021
Photo Pass
Yang Bertanda Tangan,
3x4

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Catatan:

 Formulir wajib diisi oleh peserta

 Pas foto 3x4 sebanyak 1 lembar

 Kontribusi peserta Rp. 20.000

 Formulir dan kontribusi peserta selambat – lambatnya di kembalikan pada tanggal 30 Januari 2020
di Sekretariat: Jl. Letjen Hertasning Makassar (Info CP:081338288379/085345886839)
 “Pelaksanaan Kegiatan PAB”
 Hari/Tanggal: Tanggal 31 Januari 2020
 Waktu : Pukul 17.00 WITA-Selesai
 Tempat : Tanjung