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HIMPUNAN MAHASISWA

PROGRAM STUDI BISNIS DIGITAL


INSTITUT TEKNOLOGI DAN
BISNIS TUBAN
Jln. Mloyo Kusumo, Jetak, Montong,
Tuban, Jatim
Kode pos (62357)
Telp:

FORMULIR PENDAFTARAN
CALON PENGURUS HIMPUNAN MAHASISWA PROGRAM STUDI BISNIS DIGITAL
INSTITUT TEKNOLOGI DAN BISNIS TUBAN
2023/2024

Yang bertanda tangan di bawah ini:


Nama : ..........................................................................................
Tempat/Tanggal Lahir :...........................................................................................
Jenis Kelamin : ..........................................................................................
NIM :...........................................................................................
Program Studi :...........................................................................................
Semester/Kelas :...........................................................................................
Tahun Angkatan :...........................................................................................
Alamat :...........................................................................................
No. Hp :...........................................................................................
Alamat e-mail :...........................................................................................

PENDIDIKAN
SD : ..........................................................................................
SMP/MTS : ..........................................................................................
SMA/MA/MAN :...........................................................................................

PENGALAMAN ORGANISASI
1..................................................................................................................................
2..................................................................................................................................
3. ................................................................................................................................

Tuban, ........................................
Calon pengurus HIMA
PAS PHOTO
4×6
( ................................................)
NIM.

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