REGISTRATION FORM

NAME

Annisa Humaira. N

INSTITUTION

Universitas Negeri Malang

ADDRESS
no.23 rt.10

Jl.Pramuka Gg. Manunggal

PHONE NUMBER
EMAIL

: 082226070077
: enhumaira@gmail.com

Banjarmasin,

(
..)

- Fill the registration form

- Scan / photo payment receipt
- send to: engdeptstkipbjm@gmail.com

The registration fee may be transferred to:

Bank Name
: BNI
Bank Account Name
: Tri Winindyasari Palupi
Bank Account Number : 0339980187