Registration Form

REGISTRATION FORM

Name	:……………………………………………………………..
Study Program	:……………………………………………………………..
Student’s Number	:……………………………………………………………..
Place/Date of Birth	:……………………………………………………………..
Mobile Phone	:……………………………………………………………..
Motivation to Join EMC	:……………………………………………………………..
	……………………………………………………............
	……………………………………………………............
	……………………………………………………............

Note:

1.     Returns form no later than Friday, 18 November 2011 at 16.00 at the secretariat HMPS English Study Program .

2.     Returns form administration fee of Rp. 3000,

3.     Participants who have returned this form, are required to attend the EMC meeting on Saturday, November 19th, 2011 at 15:00 in Room C8 FKIP Unhalu.

4.     For more information about EMC, please contact the contact person who exists in this form.

Ayu : (0821 8805 5275)                                                               

Lois : (0857 9600 5117)

Arul : (0852 9949 2927)                                                             

Alif : (0819 3545 2391)