12th Indonesian Students Mining Competition

Himpunan Mahasiswa Tambang – Institut Teknologi Bandung

International Students Mining Competition

Gedung Energi lt. 2, Jalan Ganesha No 10, Bandung 40132, Indonesia E-mail :
ismcitbxii@gmail.com Website : www.ismc-itb.com

PARTICIPANT’S FORM

12th INDONESIA’S STUDENTS MINING COMPETITION

UNIVERSITY : UNIVERSITAS HALU OLEO

TEAM’S NAME : NIKEL ANOA
Team Manager

Name : HAMZA
ISMC T-shirt Size : XL
Food Allergy : NONE
Team Member

Name : MUHAMMAD AGUNG ANUGRAH H.K.

ISMC T-shirt Size : XL
Food Allergy : CUCUMBER
Team Member

Name : ABDURRAHMAN IBRAHIM

ISMC T-shirt Size : XL
Food Allergy : NONE
Team Member

Name : SITTI AFRIYANI

ISMC T-shirt Size : L
Food Allergy : NONE
Team Member

Name : ULIL NUR MUHAMMAD

ISMC T-shirt Size : XL
Food Allergy : NONE
Team Member

Name : LA ODE ASRAN

ISMC T-shirt Size : L
Food Allergy : NONE
Team Member

Name : MUH. NUR RAHMAT

ISMC T-shirt Size : XL
Food Allergy : NONE
12th Indonesian Students Mining Competition

Himpunan Mahasiswa Tambang – Institut Teknologi Bandung

International Students Mining Competition

Gedung Energi lt. 2, Jalan Ganesha No 10, Bandung 40132, Indonesia
E-mail : ismcitbxii@gmail.com Website : www.ismc-itb.com
Team Member

Name : MUHAMMAD ADI

ISMC T-shirt Size : XL

Food Allergy : NONE

Estimated Time Arrival in Bandung :

Date :

Time :

Place :

Transportation :

Example.

Estimated Time Arrival in Bandung :

Date : Sunday, 2nd February 2020

Time : 10.00 am

Place : Kertajati International Airport

Transportation : Airplane

Attachment :

Size Chart :

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(..………………………………………………)

Team Captain