FORMULIR PENDAFTARAN KETUM EDSA

FORMULIR PENDAFTARAN CALON WAKIL KETUA UMUM
HIMPUNAN MAHASISWA JURUSAN BAHASA INGGRIS
UNIVERSITAS MUHAMMADIYAH PAREPARE
PERIODE 2010-2011

Nama Kampus : ____________________________________________________
Nama Lengkap : ____________________________________________________
Tempat/Tanggal Lahir : ____________________________________________________
Alamat
Kost : ____________________________________________________
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Rumah : ____________________________________________________
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Nomor Telepon/HP : ____________________________________________________
Nama Orang Tua
Ayah : ____________________________________________________
Ibu : ____________________________________________________
Pekerjaan
Ayah : ____________________________________________________
Ibu : ____________________________________________________
Motto : ____________________________________________________
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Riwayat Pendidikan : ____________________________________________________
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Pengalaman Organisasi : ____________________________________________________
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Visi : ____________________________________________________
Misi : ____________________________________________________

Parepare, …………….2010
Calon Ketua EDSA UMPAR
Periode 2010-2011



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NIM.



NB : Jika Tidak cukup boleh menggunakan kertas tambahan