UNIVERSITAS MUHAMMADIYAH MAKASSAR

ENGLISH DEPARTMENT STUDENT ASSOCIATION

NATIONAL CELEBES DEBATING CHAMPIONSHIP
Jalan Sultan Alauddin No. 259, Makassar, South Sulawesi 90221, Indonesia

REGISTRATION FORM
NATIONAL CELEBES DEBATING CHAMPIONSHIP 2014
MUHAMMADIYAH UNIVERSITY OF MAKASSAR
A. Institution Identity
Institution Name

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

Faculty/Major

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

Institution Addres

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

Institution Phone

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

Institution Email

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

B. Participant Identity
Group Name

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

st

1 Participant

nd

Full Name

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

Student Card Number

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

Place and Date of Birth

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

Home Address

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

Mobile Phone

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

Email Address

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

Full Name

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

Student Card Number

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

Place and Date of Birth

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

Home Address

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

Mobile Phone

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

Email Address

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

Participant

..............., ................................ 2014

Scan the 1st Participants signature here

Scan the 2nd Participants signature here

(..................................................................)

(.....................................................................)

Registration Regulations :
1.
2.

Registration form can be downloaded on http://ncdcunismuhmakassar.blogspot.com/

Make sure the registration form is well completed and sent to ncdc.unismuhmks@gmail.com no later than 26 May 2014