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Formulir Pengurus SSC 2015
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Nama
*
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NIM
*
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Prodi
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Tanggal Lahir
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MM
/
DD
/
YYYY
Alamat Rumah
*
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Alamat Kos
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Hobi
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Apakah punya motor?
Ya
Tidak
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Apakah punya Kamera Digital?
Ya
Tidak
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Bakat
ex : Design, Menyanyi, dll
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Apakah sedang menerima Beasiswa? Jika "Ya" sebutkan
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Nomor Handphone
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Amanah
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