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ASIAN LAW STUDENTS’ ASSOCIATION

COURTLIKE DEBATE CHAMPIONSHIP 2014
Asian Law Students’ Association Local Chapter Universitas
Airlangga Jalan Dharmawangsa Dalam Selatan, Surabaya
60286 Indonesia e-mail : acdclcunair2014@gmail.com

REGISTRATION FORM
TEAM INFORMATION
1. High School Origin

: SMAN 5 Jember

2.

High School’s Address

: Jln. Semangka No. 4 Patrang Jember

3.

High School’s Contact

:

4.

· Telephone

: (0331) 422136

· Email

: smalajember@gmail.com

Number of Team to be
Sent

: a. 1 team b. 2 team

TEAM MEMBERS INFORMATION (TEAM 1)
1st CHAIR

Name : M. LUTHFI FAKHRUDDIN
Class

3x4

: X MS 1

I have attached my English performance’s letter of approval

[write again]
.......................................................................................................
.......................................................................................................

2nd CHAIR

Name : PRISYLIA INTAN PERMATA SARI
Class : X MS 1

I have attached my English performance’s letter of approval

3x4

[write again]
......................................................................................................
......................................................................................................

“The One and Only Law Debate Concept for High School in Indonesia”

........................................................................................... 2nd CH AI R Name : YOANA ALEXANDRA RACHMAN Class : X SOS 1 I have attached my English performance’s letter of approval 3x4 [write again] .................. .....ASIAN LAW STUDENTS’ ASSOCIATION COURTLIKE DEBATE CHAMPIONSHIP 2014 Asian Law Students’ Association Local Chapter Universitas Airlangga Jalan Dharmawangsa Dalam Selatan.......................................................... ............ Surabaya 60286 Indonesia e-mail : acdclcunair2014@gmail........................................................................ ........................... ....... ....................... .........................................................com TEAM MEMBERS INFORMATION (TEAM 2) 1st CH AI R Name : ADITYA PUTRA RIANDIONO Class : X MS 1 I have attached my English performance’s letter of approval 3x4 [write again] ............... ............................

“The One and Only Law Debate Concept for High School in Indonesia” .

.ASIAN LAW STUDENTS’ ASSOCIATION COURTLIKE DEBATE CHAMPIONSHIP 2014 Asian Law Students’ Association Local Chapter Universitas Airlangga Jalan Dharmawangsa Dalam Selatan.......... ................. 2 team b.... : 3880535268 Name : Wardina Mumtazah Or Bank : Mandiri Account No.. ............ whenever you notify to make an appointment..... Vixki Intan (082131184380) before you visit..... Surabaya 60286 Indonesia e-mail : acdclcunair2014@gmail...00 a. Transfer Registration fee payment can be done by transferring to the commite’s account Bank : BCA Account No............ 300........000...... 150.. Direct Payment Please visit Faculty of Law Airlangga University and please to notify our crew.............. Rp.... : 9000021902565 ....00/team Team to be Sent Total Payment : a........ b..........000........ S.............. 085 258 101040 : ..... Elishaqy@yahoo.......000...........I Profession : Contacts : TEACHER OF SMAN 5 JEMBER MBER · Phone : ...........com TEAM ADVISOR INFORMATION Name : ROFIQ HIDAYAT.......... 150....00 Payment Method : b.com 4x6 · Email Address : .. 1 team : a..............Pd..... PAYMENT METHOD Team Registration Fee : Rp.................................... ....... We’ll always be at your service.................. Rp...........

Name : Wardina Mumtazah “The One and Only Law Debate Concept for High School in Indonesia” .

“The One and Only Law Debate Concept for High School in Indonesia” .com Please notify our crew Vixki Intan when you have done transferring process.ASIAN LAW STUDENTS’ ASSOCIATION COURTLIKE DEBATE CHAMPIONSHIP 2014 Asian Law Students’ Association Local Chapter Universitas Airlangga Jalan Dharmawangsa Dalam Selatan. Surabaya 60286 Indonesia e-mail : acdclcunair2014@gmail. and also please make 2 copies of your transfer receipts and attached it with this registration form.

. .. in his / her latest report card. Jem ber.............ASIAN LAW STUDENTS’ ASSOCIATION COURTLIKE DEBATE CHAMPIONSHIP 2014 Asian Law Students’ Association Local Chapter Universitas Airlangga Jalan Dharmawangsa Dalam Selatan.. : . .. .............. Surabaya 60286 Indonesia e-mail : acdclcunair2014@gma il..... Nam e Clas s Has been an active student in my English class.... and has attained the score of...... . .... ..com TEAM 1 1st Chair Letter of Approval of English Performance [filled and signed by English teacher] I hereby approved that my student. . 23rd of Jan uary 201 4 [ ] 2nd Chair Letter of Approval of English Performance [filled and signed by English teacher] I hereby approved that my student... : ............. .... .. for English ..for English subject.. .... ..... .... ... .. ..... Name : M.. .. .. ... .... LUTHFI FAKHRUDDIN Class : X MS 1 Has been an active student in my English class..... and has attained the score of........ . .... . ................... ....... ..... .

subject. in his / her latest report card. 23rd of January 2014 [ ] “The One and Only Law Debate Concept for High School in Indonesia” . Jember.

................. s . Surabaya 60286 Indonesia e-mail : acdclcunair2014@gmail.. . .. ..... ... and has attained the score of......... .... ............ .. ... Jember............... : . for English subject............. .. ......... me ....... ... ... .......... .... ..com TEAM 2 1st Chair Letter of Approval of English Performance [filled and signed by English teacher] I hereby approved that my student........ . ........ Clas : ........... ...... .......... in his / her latest report card............... in his / her latest report card.. : .........ASIAN LAW STUDENTS’ ASSOCIATION COURTLIKE DEBATE CHAMPIONSHIP 2014 Asian Law Students’ Association Local Chapter Universitas Airlangga Jalan Dharmawangsa Dalam Selatan...... ....... ............... 23rd of January 2014 [ ] 2nd Chair Letter of Approval of English Performance [filled and signed by English teacher] I hereby approved that my student... ... .... Na : .... Jember.......... Nam e Clas s Has been an active student in my English class.. and has attained the score of............. Has been an active student in my English class. ... ......... for English subject.... .................. 23rd of January 2014 [ ] ...............

“The One and Only Law Debate Concept for High School in Indonesia” .

Photo 3x4 4. Copy of Academic Report Card 5.ASIAN LAW STUDENTS’ ASSOCIATION COURTLIKE DEBATE CHAMPIONSHIP 2014 Asian Law Students’ Association Local Chapter Universitas Airlangga Jalan Dharmawangsa Dalam Selatan. Registration Form 2. Surabaya 60286 Indonesia e-mail : acdclcunair2014@gmail. Copy of Student Identity Card .com Required Attachments: 1. Receipt of Payment 3.

“The One and Only Law Debate Concept for High School in Indonesia” .