HIMTI ACTIVIST CANDIDATE REGISTRATION FORM
Hi there 👋🏼,

Start your journey in computer science with HIMTI.

📃 ~ Please input all your personal Information regarding the registration process of our activist candidate.
🧐 ~ Kindly recheck the form before submitting it to us to prevent any data mistakes.

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If you have any questions regarding this form, please do not hesitate to contact our staff according to your region:

📍Alam Sutera
🧑🏻‍💻Stephen Jasper
LINE : jasper1403


📍Kemanggisan
🧑🏻‍💻Kevin Sam Andaria
LINE : kevinsam14


📍Bandung
🧑🏻‍💻Yovanka Setiawan
LINE : dosilasolfamiredo123


📍Senayan
🧑🏻‍💻Gardyan Akbar
LINE : gardyan.akbar00


📍Malang
🧑🏻‍💻Stefano Wiryana
LINE : schristian23
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#HIMTI2021/2022
#OneFamilyOneGoal
Full Name *
Nama Lengkap
NIM *
Student ID
Binusian *
Ex : B2025 = Binusian 2025
Gender *
Jenis Kelamin
Birth Date *
Tanggal Lahir
MM
/
DD
/
YYYY
Active WhatsApp or Phone Number *
Nomor HP / WhatsApp yang aktif
LINE ID *
*HIMTI primarily uses LINE for communication
Major in Computer Science *
Jurusan Teknik Informatika
Region *
Regional Binusian
Address *
Alamat Lengkap
Domicile *
Domisili. Ex : Bandung
Batch of FYP *
Batch First Year Program
Email *
Email Pribadi yang Aktif. Ex: name@gmail.com
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