Download Form of JOE 6

DOWNLOAD

Registration Form

REGISTRATION FORM

Program and lodging information:  http://jsecstain.blogspot.com

Full Name:                                                                 Appropriate competition :

1.                            ____________________________________        ______________________________________

2.                           __________________________________­­­__        ______________________________________

3.                           __________________________________­­­__        ______________________________________

4.                           __________________________________­­­__        ______________________________________

5.                          __________________________________­­­__        ______________________________________

6.                          __________________________________­­­__        ______________________________________

7.                         __________________________________­­­__        ______________________________________

8.                          __________________________________­­­__        ______________________________________

University            : _____________________________________________________________

Address                : _____________________________________________________________

City                       : _____________________________________________________________

District                 : _____________________________________________________________

Zip/Postal Code   : ___________________________________________________________

Telephone            : _____________________________________________________________

Email                   : _____________________________________________________________

Note:This registration form can be copied

Payment and Technical Meeting

TECHNICAL MEETING

Place                            : M Building STAIN JuraiSiwo Metro

Day/Date                     : Sunday, May 24^th 2015 at 09.00 a.m.

Contact Person:

·          Andre Julio Pratama (0852-0835-6541)

·          Rachmad Susilo (0896-0830-9396)

·          Azzahra Aprillia (0812-7889-5055)

·          M. Najmussaqib Diya Alhaq (0856-5877-5023)

Aprianita Ade Ninggar (0857-6805-3266). 

The participants can transfer the registration fee hereby:

(a.n. Anita Pratiwi, Bank BRI, Nomor Rekening (0130-01-061309-50-5). Download the registration form on http://jsecstain.blogspot.com or send an email to fill the registration form completely. Scan the registration form and the receipt of your money transfer to jsecstain1@gmail.com. Bring the original one on the technical meeting. If you’ve transfer the registration fee, please confirm to our CP below.