INFO LOMBA UPH

UNIVERSITAS PELITA HARAPAN PRESENT

EARTHQUAKE RESISTANCE BUILDING COMPETITION 2014___________________

REGISTRATION FORM

Nama Institusi                        :                                                                                                     

Alamat Institusi                      :                                                                                                     

                                                                                                                                                      

                                                                                                                                                      

Pembimbing                           :                                                                                                     

Telephone/Fax                        :                                                                                                     

Nama Kelompok                    :                                                                                                     

Data Anggota Kelompok       :                                                                                                     

1.    Nama                        :                                                                                                     

No. HP                     :                                                                                                     

Email                        :                                                                                                     

2.    Nama                        :                                                                                                     

No. HP                     :                                                                                                     

Email                        :                                                                                                     

3.    Nama                        :                                                                                                     

No. HP                     :                                                                                                     

Email                        :                                                                                                     

4.    Nama                        :                                                                                                     

No. HP                     :                                                                                                     

Email                        :                                                                                                     

Nb         : Surat Keterangan Dari Institusi yang Bersangkutan Harus Dilampirkan