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
th
12 INDONESIA’S STUDENTS MINING COMPETITION

UNIVERSITY : …………………………………………………………………..
TEAM’S NAME : …………………………………………………………………..
Team Manager

Name : ……………………………………………………………………………………
ISMC T-shirt Size : ……………………………………………………………………………………
Food Allergy : ……………………………………………………………………………………
Team Member

Name : ……………………………………………………………………………………
ISMC T-shirt Size : ……………………………………………………………………………………
Food Allergy : ……………………………………………………………………………………
Team Member

Name : ……………………………………………………………………………………
ISMC T-shirt Size : ……………………………………………………………………………………
Food Allergy : ……………………………………………………………………………………
Team Member

Name : ……………………………………………………………………………………
ISMC T-shirt Size : ……………………………………………………………………………………
Food Allergy : ……………………………………………………………………………………
Team Member

Name : ……………………………………………………………………………………
ISMC T-shirt Size : ……………………………………………………………………………………
Food Allergy : ……………………………………………………………………………………
Team Member

Name : ……………………………………………………………………………………
ISMC T-shirt Size : ……………………………………………………………………………………
Food Allergy : ……………………………………………………………………………………
Team Member

Name : ……………………………………………………………………………………
ISMC T-shirt Size : ……………………………………………………………………………………
Food Allergy : ……………………………………………………………………………………
 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 : ……………………………………………………………………………………
ISMC T-shirt Size : ……………………………………………………………………………………
Food Allergy : ……………………………………………………………………………………

Estimated Time Arrival in Bandung :

Date :
Time :
Place :
Transportation :

Example.
Estimated Time Arrival in Bandung :
nd
Date : Sunday, 2 February 2020
Time : 10.00 am
Place : Kertajati International Airport
Transportation : Airplane

Attachment :
Size Chart :

.…………………, ……………………………

(..………………………………………………)
Team Captain