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Pendaftaran peserta PKKMB Fakultas Kelautan dan Perikanan tahun 2017
Nama lengkap *
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NIM *
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Jenis Kelamin *
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Prodi/jurusan *
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Tempat dan Tanggal Lahir *
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Alamat tinggal sekarang *
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No telpon / HP *
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No telpon / HP Orang Tua *
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Vegetarian / Non vegetarian *
Riwayat Penyakit *
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Motto *
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