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KOFITA (Komunitas Film Kita) 
Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia 
Email : kofita@ymail.com – facebook : kofita ( komunitas filtasikmalaya ) 
Cp : Rian : 08986704000 
------------------------------------------------------------------------------------------------------------------------------------------------------------ 
Formulir Pendaftaran FFT #3, RANCAGE 
Nama Pendaftar 
Alamat 
Sekolah / Universitas/ Komunitas 
No Hp 
Email 
Judul Film 
Tahun Pembuatan 
Durasi 
Link Youtube 
Apakah film ini pernah diikut sertakan festival ? 
Apakah film ini pernah mendapatkan penghargaan ? 
Apa yang kamu harapkan dari FFT #3, RANCAGE ini ? 
------------------------------------------------------------------------------------------------------------------------------------------------------------ 
Karya dikirim paling lambat 5 Desember 2014 
Kirimkan formulir dan data pendukung ke panitia melalui email kofita@ymail.com 
Kirim langsung atau via pos : Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia
KOFITA (Komunitas Film Kita) 
Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia 
Email : kofita@ymail.com – facebook : kofita ( komunitas filtasikmalaya ) 
Cp : Rian : 08986704000 
------------------------------------------------------------------------------------------------------------------------------------------------------------ 
Sinopsis (mak 500 kata) 
------------------------------------------------------------------------------------------------------------------------------------------------------------ 
Karya dikirim paling lambat 5 Desember 2014 
Kirimkan formulir dan data pendukung ke panitia melalui email kofita@ymail.com 
Kirim langsung atau via pos : Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia
KOFITA (Komunitas Film Kita) 
Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia 
Email : kofita@ymail.com – facebook : kofita ( komunitas filtasikmalaya ) 
Cp : Rian : 08986704000 
------------------------------------------------------------------------------------------------------------------------------------------------------------ 
Surat Pernyataan Peserta FFT #3, RANCAGE 
Saya yang bertanda tangan di bawah ini 
Nama : 
Adalah penanggung jawab dari penyerahan film untuk FFT #3, RANCAGE dengan judul 
film? 
Dengan ini menyatakan : Saya telah membaca dengan seksama syarat dan 
ketentuan yang terdapat dalam kompetisi FFT #3, RANCAGE dan dengan ini 
mengikatkan diri dalam syarat dan ketentuan tersebut. Adapun film dan data yang saya 
isikan adalah benar juga dapat dipertanggung jawabkan. 
Nama Lengkap 
Tanda Tangan 
------------------------------------------------------------------------------------------------------------------------------------------------------------ 
Karya dikirim paling lambat 5 Desember 2014 
Kirimkan formulir dan data pendukung ke panitia melalui email kofita@ymail.com 
Kirim langsung atau via pos : Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia

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KOFITA Formulir FFT3 RANCAGE

  • 1. KOFITA (Komunitas Film Kita) Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia Email : kofita@ymail.com – facebook : kofita ( komunitas filtasikmalaya ) Cp : Rian : 08986704000 ------------------------------------------------------------------------------------------------------------------------------------------------------------ Formulir Pendaftaran FFT #3, RANCAGE Nama Pendaftar Alamat Sekolah / Universitas/ Komunitas No Hp Email Judul Film Tahun Pembuatan Durasi Link Youtube Apakah film ini pernah diikut sertakan festival ? Apakah film ini pernah mendapatkan penghargaan ? Apa yang kamu harapkan dari FFT #3, RANCAGE ini ? ------------------------------------------------------------------------------------------------------------------------------------------------------------ Karya dikirim paling lambat 5 Desember 2014 Kirimkan formulir dan data pendukung ke panitia melalui email kofita@ymail.com Kirim langsung atau via pos : Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia
  • 2. KOFITA (Komunitas Film Kita) Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia Email : kofita@ymail.com – facebook : kofita ( komunitas filtasikmalaya ) Cp : Rian : 08986704000 ------------------------------------------------------------------------------------------------------------------------------------------------------------ Sinopsis (mak 500 kata) ------------------------------------------------------------------------------------------------------------------------------------------------------------ Karya dikirim paling lambat 5 Desember 2014 Kirimkan formulir dan data pendukung ke panitia melalui email kofita@ymail.com Kirim langsung atau via pos : Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia
  • 3. KOFITA (Komunitas Film Kita) Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia Email : kofita@ymail.com – facebook : kofita ( komunitas filtasikmalaya ) Cp : Rian : 08986704000 ------------------------------------------------------------------------------------------------------------------------------------------------------------ Surat Pernyataan Peserta FFT #3, RANCAGE Saya yang bertanda tangan di bawah ini Nama : Adalah penanggung jawab dari penyerahan film untuk FFT #3, RANCAGE dengan judul film? Dengan ini menyatakan : Saya telah membaca dengan seksama syarat dan ketentuan yang terdapat dalam kompetisi FFT #3, RANCAGE dan dengan ini mengikatkan diri dalam syarat dan ketentuan tersebut. Adapun film dan data yang saya isikan adalah benar juga dapat dipertanggung jawabkan. Nama Lengkap Tanda Tangan ------------------------------------------------------------------------------------------------------------------------------------------------------------ Karya dikirim paling lambat 5 Desember 2014 Kirimkan formulir dan data pendukung ke panitia melalui email kofita@ymail.com Kirim langsung atau via pos : Jl. Seladarma No. 90 Kota Tasikmalaya– Jawa Barat – Indonesia