FORMULIR
PENDAFTARAN ANGGOTA & PENGURUS SIC
Nama :
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TTL :
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Asal Universitas:
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Prodi/Jurusan :
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Agama : ______________________________________________________________________________
No HP/FB :
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Alamat Asal :
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Alamat di Jogja:
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Hobi :
1. ______________________________________________________________________________________
2.
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3.
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4.
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Kelebihan yang Dimiliki :
1. ______________________________________________________________________________________
2.
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3. ______________________________________________________________________________________
4.
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5.
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6.
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7.
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8.
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9.
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10.
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Pilihan Utama : ( Pengurs SIC / Anggota SIC ) * lingkari
yg dipilih
Pilihan Bidang
Utama (Boleh Lebih dari 1) :
1. BIDANG PENDIDIKAN DAN PELATIHAN ( ....... )*
2. BIDANG DANA USAHA ( ....... )*
3. BIDANG SOSIAL DAN KEROHANIAN (
....... )*
4. BIDANG HUMAS DAN PENGKADERAN (
....... )*
5. BIDANG INFORMASI DAN PENERBITAN ( ....... )*
Motivasi Ingin
Ikut SIC :
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........................................................................................................................................................................................................................................................................................................................................................................................................................................................
Panitia
SIC,
Yogyakarta,
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Pendaftar
