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://ncdc.unismuh.blogspot.com/

Make sure the registration form is well completed and sent to ncdc.unismuh@gmail.com no later than 16 June
2014