FORMULIR PENDAFTARAN

PEKAN OLAHRAGA MAHASISWA WIRARAJA (POMJA)

UNIVERSITAS WIRARAJA
TAHUN 2022
Jenis Lomba : Bola Voli

Nama Delegasi : ..........................................................................................

Nama Official : ..........................................................................................

No. WA (Official) : ..........................................................................................

Nama Peserta : ..........................................................................................

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KET : Melampirkan fotocopy KTM setiap pemain

Pas foto ukuran 3x4 dua lembar setiap pemain

Sumenep,....................

Peserta/Official
 ...................................

FORMULIR PENDAFTARAN

PEKAN OLAHRAGA MAHASISWA WIRARAJA (POMJA)

UNIVERSITAS WIRARAJA
TAHUN 2022
Jenis Lomba : Futsal

Nama Delegasi : ..........................................................................................

Nama Official : ..........................................................................................

No. WA (Official) : ..........................................................................................

Nama Peserta : ..........................................................................................

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9. ...............................................................................................................
10 ...............................................................................................................
.

KET : Melampirkan fotocopy KTM setiap pemain

Pas foto ukuran 3x4 dua lembar setiap pemain

Sumenep,....................

Peserta/Official

...................................
 FORMULIR PENDAFTARAN

PEKAN OLAHRAGA MAHASISWA WIRARAJA (POMJA)

UNIVERSITAS WIRARAJA
TAHUN 2022
Jenis Lomba : Bola Basket

Nama Delegasi : ..........................................................................................

Nama Official : ..........................................................................................

No. WA (Official) : ..........................................................................................

Nama Peserta : ..........................................................................................

1. ...............................................................................................................
2. ...............................................................................................................
3. ...............................................................................................................
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8. ...............................................................................................................
9. ...............................................................................................................
10 ...............................................................................................................
.

KET : Melampirkan fotocopy KTM setiap pemain

Pas foto ukuran 3x4 dua lembar setiap pemain

Sumenep,....................

Peserta/Official
 ...................................

FORMULIR PENDAFTARAN

PEKAN OLAHRAGA MAHASISWA WIRARAJA (POMJA)

UNIVERSITAS WIRARAJA
TAHUN 2022
Jenis Lomba : Bulu Tangkis (Tunggal,Ganda)

Nama Delegasi : ..........................................................................................

Nama Official : ..........................................................................................

No. WA (Official) : ..........................................................................................

Nama Peserta : ..........................................................................................

1. ...............................................................................................................
2. ...............................................................................................................

KET : Melampirkan fotocopy KTM setiap pemain

Pas foto ukuran 3x4 dua lembar setiap pemain

Sumenep,....................

Peserta/Official

...................................
 FORMULIR PENDAFTARAN

PEKAN OLAHRAGA MAHASISWA WIRARAJA (POMJA)

UNIVERSITAS WIRARAJA
TAHUN 2022
Jenis Lomba : Catur

Nama Delegasi : ..........................................................................................

Nama Official : ..........................................................................................

No. WA (Official) : ..........................................................................................

Nama Peserta : ..........................................................................................

1. ...............................................................................................................

KET : Melampirkan fotocopy KTM setiap pemain

Pas foto ukuran 3x4 dua lembar setiap pemain

Sumenep,....................

Peserta/Official

...................................
 FORMULIR PENDAFTARAN

PEKAN OLAHRAGA MAHASISWA WIRARAJA (POMJA)

UNIVERSITAS WIRARAJA
TAHUN 2022
Jenis Lomba : E-Sport

Nama Delegasi : ..........................................................................................

Nama Tim/Squad : ..........................................................................................

Nama Official : ..........................................................................................

No. WA (Official) : ..........................................................................................

1. Kapten : ..........................................................................................
2. Player 1 : ..........................................................................................
3. Player 2 : ..........................................................................................
4. Player 3 : ..........................................................................................
5. Player 4 : ..........................................................................................
6. Cadangan : ..........................................................................................

KET : Melampirkan fotocopy KTM setiap pemain

Pas foto ukuran 3x4 dua lembar setiap pemain

Sumenep,....................

Peserta/Official

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