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PT.

GOLDEN MEDIKA MANDIRI


Jl. Raya Kalirungkut 27/C No. 65, Surabaya
Telp. : (62-31) 8797770 / 8797771, Fax. : (62-31) 8711273
Email : mitrabahagiasby@gmail.com

Daftar Peserta Training


Date/ Tanggal

Hospital Name & Address


Nama Rumah Sakit & Alamat

ABOUT THE MACHINE


Type/SN
Tipe/Nomer Seri

Installation Date
Tanggal Install

TRAINEE LIST
Peserta Training

Name Position Signature Question


Name Position Signature Question

TRAINER SIGNATURE
Tanda Tangan

( )

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