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Formulir Registrasi Peserta Uji Kompetensi
Calon peserta Bimbingan Teknis dan Uji Kompetensi Kultur Jaringan harap mengisi data sesuai KTP
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Nama Lengkap
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Your answer
NIK (Nomor Induk Kependudukan)
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Your answer
Tempat Lahir (Kabupaten/ Kota)
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Your answer
Tanggal Lahir
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MM
/
DD
/
YYYY
Jenis Kelamin
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Laki laki
Perempuan
Tempat Tinggal (alamat sesuai data KTP)
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Kabupaten/ Kota
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Your answer
Provinsi
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Your answer
No. Telepon (WhatsApp)
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Email
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Tuliskan alamat email anda yang aktif
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NIM/ NIP/ NRP
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Instansi
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Contoh format: Jurusan, Fakultas, Universitas
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Alamat Tinggal Sementara
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Jika tidak ada, tuliskan angka "0"
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