1. PANITIA PEKAN REMAJA TEGAR PIKMA-SRIWIJAYA
PUSAT INFORMASI DAN KONSELING MAHASISWA SRIWIJAYA
( PIKMA-SRIWIJAYA )
UNIVERSITAS PEKALONGAN
Jl. Sriwijaya No.3, Pekalongan
CP :
Danang Prabowo (085647395969)
Yulis Indriyani (085741983529)
FORMULIR PENDAFTARAN
LOMBA POSTER PEMAGAR
KATEGORI : PELAJAR / MAHASISWA/UMUM
NAMA :........................................................................................................
TTL :.......................................................................................................
ALAMAT :......................................................................................................
JENIS KELAMIN : LAKI-LAKI/ PEREMPUAN
ASAL SEKOLAH/INSTANSI :......................................................................................................
ALAMAT SEKOLAH/INSTANSI :......................................................................................................
NO. HP :......................................................................................................
E-MAIL/ Facebook :.....................................................................................................
NB : *isi dengan huruf capital
*coret yang tidak perlu.
* info lebih lanjut hubungi CP
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