11th Indonesian Students Mining Competition

Himpunan Mahasiswa Tambang Institut Teknologi Bandung

International Students Mining Competition
Gedung Energi lt. 2, Jalan Ganesha 10, Bandung 40132, Indonesia
E-mail : ismcxi@gmail.com Website : www.ismc-itb.com

REGISTRATION FORM

UNIVERSITY : ..
TEAMS NAME : ..

Team Captain
Name :
Student ID :
Photo
Address :
Blood Type :
Disease :
3X4
Phone Number :

Team Member
Name :
Student ID : Photo
Address :
Blood Type :
3x4
Disease :
Phone Number :

Team Member
Name :
Student ID : Photo
Address :
Blood Type :
3X4
Disease :
Phone Number :

Team Member
Name :
Student ID : Photo
Address :
Blood Type :
3x4
Disease :
Phone Number :
 11th Indonesian Students Mining Competition
Himpunan Mahasiswa Tambang Institut Teknologi Bandung
International Students Mining Competition
Gedung Energi lt. 2, Jalan Ganesha 10, Bandung 40132, Indonesia
E-mail : ismcxi@gmail.com Website : www.ismc-itb.com

Team Member
Name :
Student ID :
Photo
Address :
Blood Type :
3X4
Disease :
Phone Number :

Team Member
Name :
Photo
Student ID :
Address :
Blood Type :
3x4
Disease :
Phone Number :

Team Member
Name :
Student ID :
Photo
Address :
Blood Type : 3X4
Disease :
Phone Number :

Team Manager
Name : Photo
Student ID :
Address : 3X4
Blood Type :
Disease :
Phone Number :
 11th Indonesian Students Mining Competition
Himpunan Mahasiswa Tambang Institut Teknologi Bandung
International Students Mining Competition
Gedung Energi lt. 2, Jalan Ganesha 10, Bandung 40132, Indonesia
E-mail : ismcxi@gmail.com Website : www.ismc-itb.com

.,

(..)
Team Captain