Contoh Formulir Pendaftaran MAPABA

FORMULIR PENDAFTARAN

MASA PENERIMAAN ANGGOTA BARU (MAPABA)

PERGERAKAN MAHASISWA ISLAM INDONESIA (PMII)

RAYON BRANTAS & WALI SONGO

KOMISARIAT TRIBAKTI KEDIRI

MASA KHIDMAT 2015-2016

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Motivasi Ikut PMII

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Dengan Ini maka saya siap untuk mengikuti MAPABA PMII Rayon Brantas & Wali Songo Komisariat Tribakti Kediri Masa Khidmat 2014-2015.

Kediri, .......... September 2015

                               

Panitia                                                                    Peserta

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Contact Person

1.     Syamsul Aripin. Tarbiyah  Smt III                                      (0857-760-327-56)

2.     M. Khadikul Fikri. Dakwah Smt III                                     (0857-848-483-20)

3.     A. Nurul Fajriansyah Syari’ah Smt III                               (0896-438-926-99)

Registrasi:

1.       Tribakti                : Rp. 35.000

2.       Delegasi                : Rp. 50.000