PANITIA PELAKSANA

LATIHAN DASAR KEPEMIMPINAN (LDK)

HIMPUNAN MAHASISWA PRODI TADRIS MATEMATIKA (HIMAPRISMA)
FAKULTAS TARBIYAH DAN ILMU KEGURUAN
UNIVERSITAS ISLAM AHMAD DAHLAN SINJAI
PERIODE 2023-2024
Sekretariat :Jl. Doktor Samratulangi Kec. Sinjai Utara, Kab. Sinjai, Prov. Sulawesi Selatan.
Email :himaprismaiaim@gmail.com Telp : 082291529295

FORMULIR PENDAFTARAN
LATIHAN DASAR KEPEMIMPINAN (LDK)

Nama :........................................................................................................................
NIM :........................................................................................................................
Tempat/Tanggal Lahir :........................................................................................................................
Alamat :........................................................................................................................
Nomor HP/WhatsApp :........................................................................................................................
Nama Orang Tua
- Ayah :........................................................................................................................
- Ibu :........................................................................................................................
Nomor HP/WhatsApp :........................................................................................................................
Riwayat Penyakit :........................................................................................................................
Riwayat Pendidikan
- SD :........................................................................................................................
- SMP :........................................................................................................................
- SMA :........................................................................................................................
Sosial Media
- Email :........................................................................................................................
- Facebook :........................................................................................................................
- Instagram :........................................................................................................................
Pengalaman Berorganisasi : 1.....................................................................................................................
2.....................................................................................................................
3.....................................................................................................................
4.....................................................................................................................
5.....................................................................................................................
Motto Hidup :........................................................................................................................
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Sinjai, .... Oktober 2023

Peserta

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Catatan:
- Biaya pendaftaran Rp. 50.000,- (Beras + Telur + Susu) dan Rp. 70.000,-
- CP: Sekretaris Panitia (0822-9152-9295)
Formulir dikembalikan paling lambat hari Kamis, 26 Oktober 2023 pada panitia pelaksana
 PANITIA PELAKSANA
LATIHAN DASAR KEPEMIMPINAN (LDK)
HIMPUNAN MAHASISWA PRODI TADRIS MATEMATIKA (HIMAPRISMA)
FAKULTAS TARBIYAH DAN ILMU KEGURUAN
UNIVERSITAS ISLAM AHMAD DAHLAN SINJAI
PERIODE 2023-2024
Sekretariat :Jl. Doktor Samratulangi Kec. Sinjai Utara, Kab. Sinjai, Prov. Sulawesi Selatan.
Email :himaprismaiaim@gmail.com Telp : 082291529295

Catatan:
- Biaya pendaftaran Rp. 50.000,- (Beras + Telur + Susu) dan Rp. 70.000,-
- CP: Sekretaris Panitia (0822-9152-9295)
Formulir dikembalikan paling lambat hari Kamis, 26 Oktober 2023 pada panitia pelaksana