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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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