FORMULIR PENDAFTARANPESERTA PELATIHAN DASAR TEKNIK INSTRUKSIONAL (PEKERTI)KOPERTIS WILAYAH IXTAHUN 2015Nama : Faisal N!"si#$ S%Fa"m$ A&'$ M%P%HT(m&a')T*l%la+i" : U,!-* Pa-#a-*)02 F(."!a"i 1/01NIDN : 0/02020102Alama' R!ma+ : K2m& P(33a.a'a$ K(l!"a+a- Da"ma$ K(4%P2l(5ali% Ka.% P2l(5ali 6a"a'Alama' Email : 7aisal-!"si#89a+22%42mN2m2" HP : 0052555:50;5Pa-*3a')a.%A3a#(mi3 D2s(-: 6(l!m A#aU-i' K(",a (PTS) : U-i?("si'as Al As9a"ia+ Ma-#a"P2l(5ali$10 A*!s'!s 2015Faisal N!"si#$ S%Fa"m$ A&'$ M%P%H NIDN : 0/02020102%SURAT PERNYATAAN@ALON PESERTA PEKERTI TAHUN 20156a+5a sa9a:Nama : Faisal N!"si#$ S%Fa"m$ A&'$ M%P%HNIDN : 0/02020102U-i' K(",a : U-i?("si'as Al As9a"ia+ Ma-#a"A3a-m(-*i3!'i&(la'i+a-s(s!ai5a3'!9a-*'(la+#i'('a&3a-%Da-$.("s(#ia!-'!3#i.a'al3a-3(i3!'s("'aa-sa9a&a#aPEKERTITa+!-2015$a&a.ila#i-9a'a3a-'i#a3m(-*i3!'i 3('(-'!a- 9a-* .("la3!%D(mi3ia- &("-9a'aa- i-i sa9a .!a' #(-*a- &(-!+ 'a-**!-* ,a5a.%P2l(5ali$ 10 A*!s'!s 2015Faisal N!"si#$ S%Fa"m$ A&'$ M%P%H NIDN : 0/02020102