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KOMISI PEMILIHAN RAYAPresiden dan Wakil Presiden BEM serta Anggota DLM KBMF
Universitas Jenderal SoedirmanSekertariat Jl. dr. Soeparno Kampus Karangwangkal telp/fax (0281) 642840 Purwokerto 53122
Purwokerto 53122
FORMULIR PENDAFTARAN
CALON ANGGOTA DLM KBMF UNSOED
PERIODE 201 6 -201 6
I. BIODATA DIRI
Nama Lengkap :________________________________________________
Nama Panggilan : ________________________________________________
Jenis Kelamin : ________________________________________________
Tempat Tanggal Lahir : ________________________________________________
NIM : ________________________________________________
Fakultas/Departemen : ________________________________________________
Agama : ________________________________________________
No. Hp : ________________________________________________
Email dan facebook : ________________________________________________
Blog/Website : ________________________________________________
Anak ke-, dari - ..saudara : ________________________________________________
Asal SMA : ________________________________________________
Asal Daerah : ________________________________________________
Mottto Hidup : ________________________________________________
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Motivasi :________________________________________________
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Purwokerto,.............................2015
Calon Anggota DLM
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NIM.
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