UNIVERSITAS MUHAMMADIYAH YOGYAKARTA

ENGLISH DEPARTMENT STUDENT ASSOCIATION

W

Jalan Lingkar Selatan Tamantirta Kasihan Bantul Yogyakarta 55183

http://needumy2013.blogspot.com
needumy2013@gmail.com

RE-REGISTRATION FORM
NATIONAL ENGLISH EDUCATION DEBATE UMY 2013
A. Institution Identity
Institution Name

:..............................................................................................

Name of Faculty/Major

: .

B. Group Identity
Group Name (University Abbreviation A/B/C)..................................................................:

C. Participant Identity
Speaker
Full Name

:..........................................................................................

Allergies/Personal Diseases:..........................................................................................*)
Dietary restrictions

: ..........................................................................................*)

Speaker
Full Name

:...........................................................................................

Allergies/Personal Diseases:..........................................................................................*)
Dietary Restrictions

: ..........................................................................................*)

....................., .............................. 2013

*) Please write NONE if you do not have any alergies/personal disease or diatery restriction.