formulir futsal

FORMULIR PENDAFTARAN

UKM FUTSAL UNHASY

Nama                                                   : ......................................................................................

NIM                                                    : ......................................................................................

Fakultas/Jurusan/Kelas                        : .....................................................................................

Semester                                              : .....................................................................................

Telephone/HP                                     : .....................................................................................

Email                                                   : .....................................................................................

Alamat                                                 : .....................................................................................

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Jenis UKM                                          : .....................................................................................

Alasan Pemilihan UKM                      : ..................................................................................

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Alasan Pembukaan UKM                  : .....................................................................................................................................................

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Bertanda tangan di bawah ini, bersedia mengikuti Unit Kegiatan Mahasiswa secara sportifitas dan siap mengikuti segala syarat UKM yang didaftar.

Jombang , ..............

Mahasiswa,

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Cp: Akbar/Pak Resdi