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Tuesday, November 22, 2011

Registration Form

REGISTRATION FORM
Name
:……………………………………………………………..
emc.jpgStudy 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.

emc.jpgAyu : (0821 8805 5275)                                                               
Lois : (0857 9600 5117)
Arul : (0852 9949 2927)                                                             
Alif : (0819 3545 2391)

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