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HIMIKA STIKes MADANI YOGYAKARTA 2012-2013
FORMULIR PENDAFTARAN CALON PENGURUS HIMIKA 2013-2014
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Nama
*
Nama Anda
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NIM
*
M10.000xxxxx
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Tempat Tanggal Lahir
*
Yogyakarta, 12 Mei 2013
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Jenis Kelamin
*
Laki-Laki
Perempuan
Semester
*
II (Dua)
IV (Empat)
VI (Enam)
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Alamat Asal
*
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Alamat Sekarang
*
Jln. Wonosari Km 10 XXXX
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Handphone
*
087832xxxxxxx
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Jabatan Yang di Inginkan
*
Ketua
Wakil Ketua
Sekretaris
Bendahara
Advokasi
Divisi Litbang
Pengembangan Organisasi
Humas
Dana & Usaha
Pengabdian Masyarakat
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Alasan Mendaftar Sebagai Pengurus HIMIKA
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