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  • Application Form 2012

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    Tri Nata
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    This document is an application form requesting information such as name, photo, nickname, student ID number, date of birth, addresses, phone number, email, major, motivation to join AMSA, organization experience, event experience, motto, and preferred divisions from applicants. It collects basic personal details as well as experience and interests relevant to the application.

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    This document is an application form requesting information such as name, photo, nickname, student ID number, date of birth, addresses, phone number, email, major, motivation to join AMSA, organization experience, event experience, motto, and preferred divisions from applicants. It collects basic personal details as well as experience and interests relevant to the application.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
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    8 views1 page

    Application Form 2012

    Uploaded by

    Tri Nata
    This document is an application form requesting information such as name, photo, nickname, student ID number, date of birth, addresses, phone number, email, major, motivation to join AMSA, organization experience, event experience, motto, and preferred divisions from applicants. It collects basic personal details as well as experience and interests relevant to the application.

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    Application Form

    Name

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

    Foto
    Nickname

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

    NIM

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

    3x4

    Date of Birth : ....................................................................................................................


    Original Address

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

    Address in Malang : .........................................................................................................


    Cellphone Number : .........................................................................................................
    Email

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

    Majority*

    : Medical/Dietitian/Nursery/Dentistry/Pharmacist/Midwifery

    Join Staff Magang: Yes/ No


    Motivation to Join AMSA :...............................................................................................
    Organization Experience : 1............................................3.............................................
    2............................................4.............................................
    Event Experience

    : 1.......................................... 3.............................................
    2.............................................4.............................................

    Motto

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

    Division that you are interested in*:


    1. MnD/DoA/AMSEP/PnP/ET/RnA/Club/Gensec/Treasurer
    2. MnD/DoA/AMSEP/PnP/ET/RnA/Club/Gensec/Treasurer
    3. MnD/DoA/AMSEP/PnP/ET/RnA/Club/Gensec/Treasurer
    *)

    give strikethrough (a/b/c) to the not

    Malang,

    2013

    (Applicant signature)

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