ASRAMI JAMIL : FORMULIR PENDAFTARAN MANAJEMEN ALAM BEBAS FAKULTAS KEHUTANAN DAN ILMU LINGKUNGAN UNIVERSITAS HALU OLEO

PANITIA PELAKSANA MANAJEMEN ALAM BEBAS IX

BADAN EKSEKUTIF MAHASISWA

FAKULTAS KEHUTANAN DAN ILMU LINGKUNGAN

Sekretariat; jl.Mayjen S Parman, Kampus Kemara UHO, Gedung PKM FHIL UHO. Cp.085395961692

 

FORMULIR PENDAFTARAN­­­­

MANAJEMEN ALAM BEBAS (MABES) IX

FAKULTAS KEHUTANAN DAN ILMU LINGKUNGAN

UNIVERSITAS HALU OLEO

1.       Nama Lengkap                                :  ...........................................................................

2.       Nama Panggilan                              :  ...........................................................................

3.       Tempat/Tanggal Lahir                     :  ...........................................................................

4.       Jenis Kelamin                                  :  ...........................................................................

5.       A g a m a                                         :  ...........................................................................

6.       Golongan Darah                              :  ...........................................................................

7.       A l a m a t                                       :  ...........................................................................

8.       No. Telp/HP*)                                 :  ...........................................................................

9.       E m a i l                                           :  ...........................................................................

10.   H o b i                                             :  ...........................................................................

11.   Pendidikan

a.       SD/Sederajat                             :  di ....................................lulus thn .............................

b.       SMP/Sederajat                          :  di ....................................lulus thn .............................

c.       SMA/Sederajat                         :  di ....................................lulus thn .............................

d.      Angkatan                                  :  .............................................................................................

12.   Prestasi yang Diraih                        :  .............................................................................................

13.   Pengamalan Organisasi                   :  .............................................................................................

      .....................................................................................................................................................      .....................................................................................................................................................

14.   Penyakit yang Diderita                   :  .............................................................................................

15.   Tujuan Mengikuti Manajemen Alam Bebas  :  ..................................................................................................................................................................................................................................................................................................................................................................................................

*)   Wajib Diisi

Kendari,        Januari 2015

Mahasiswa Ybs.

 

Catatan :  -  Isilah dengan jujur sesuai dengan kesadaran saudara