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  • Early Registration Resident Edit

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    Wira Dharma
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    This early registration form requests information such as name, date of birth, gender, religion, contact details, clothing size, dietary restrictions, and payment details from applicants registering for a university resident program in 2013. It informs applicants that the early registration deadline is March 12, 2013 and that the payment of Rp 325,000 should be made via a Mandiri bank account to the name provided, with confirmation of payment sent to the listed contacts.

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    This early registration form requests information such as name, date of birth, gender, religion, contact details, clothing size, dietary restrictions, and payment details from applicants registering for a university resident program in 2013. It informs applicants that the early registration deadline is March 12, 2013 and that the payment of Rp 325,000 should be made via a Mandiri bank account to the name provided, with confirmation of payment sent to the listed contacts.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    6 views2 pages

    Early Registration Resident Edit

    Uploaded by

    Wira Dharma
    This early registration form requests information such as name, date of birth, gender, religion, contact details, clothing size, dietary restrictions, and payment details from applicants registering for a university resident program in 2013. It informs applicants that the early registration deadline is March 12, 2013 and that the payment of Rp 325,000 should be made via a Mandiri bank account to the name provided, with confirmation of payment sent to the listed contacts.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    Download as docx, pdf, or txt
    of 2

    EARLY REGISTRATION FORM

    RESIDENT 2013
    Insert
    photo
    here
    3x4

    University

    : ____________________________________________________

    Name

    : ____________________________________________________

    Date of Birth

    : ____________________________________________________

    Gender

    : ____________________________________________________

    Religion

    : ____________________________________________________

    Height

    : ____________________________________________________

    Weight

    : ____________________________________________________

    Mobile

    : ____________________________________________________

    Pin BB

    : ____________________________________________________

    Email

    : ____________________________________________________

    Twitter/FB

    : ____________________________________________________

    Sites

    : (please bold/underline one of the options below)

    Clothes size

    : (please bold/underline one of the options below)

    Vegetarian

    Representative
    AB
    EB
    Delegates
    Observer

    S
    M
    L
    XL
    XXL

    : (please bold/underline one of the options below)


    YES
    NO

    Allergic

    : ____________________________________________________

    CONTACT PERSON

    A.D Wulandari S.P


    (082393056490/2308EF10)
    Restian Tri Pramutya
    (085299998912/29880B22)
    Email : nltamsaumi@gmail.com

    Payment for Early Registration Rp 325.000,00 (deadline : March


    12th 2013)
    Mandiri : 900-00-1364172- 6
    Name : Dhian Karina Aprilani H
    Please confirm us if you done the payment : Dhian Karina Aprilani H ( 08975542658)
    Please send back this form to nltamsaumi@gmail.com
    (before : March 12th , 2013. 23:59 WITA)

    CONTACT PERSON

    A.D Wulandari S.P


    (082393056490/2308EF10)
    Restian Tri Pramutya
    (085299998912/29880B22)
    Email : nltamsaumi@gmail.com

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