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PANITIA PELAKSANA BASIC TRAINNING ( LK-I ) ANGKATAN KE– III HIMPUNAN MAHASISWA ISLAM KOMISARIAT TEKNIK UNIVERSITAS PATTIMURA AMBON (Engeneering Commisariate of Pattimura University) Sekretariat : Jl. Ir. Putuhena –BTN Poka Perumnas. HP : 082198084086/082310688108



FORMULIR PENDAFTARAN



Yang bertanda tangan di bawah ini : Nama Tempat Tanggal Lahir Universitas Fakultas/Jurusan Alamat No HP/PIN BB Facebook



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Pengalaman Organisasi : 1. ............................................................... 2. .............................................................. 3. .............................................................. 4. ............................................................ 5. ............................................................... Motivasi Masuk HMI: .............................................................................................................................................. ............................................................................................................................................... ..... ................................................................................................................................................. Dengan penuh kesadaran dan rasa tanggung jawab serta tanpa paksaan dari siapapun dan pihak manapun, saya bersedia mengikuti kegiatan Basic Training (LKI-I) yang diselenggarakan oleh Pengurus Himpunan Mahasiswa Islam (HMI) Cabang Ambon Komisariat Teknik Unpatti Ambon. Billahitaufiq Walhidayah Ambon, .........................2015 FOTO 2X3



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