KOORDINATOR OLIMPIADE KIMIA SMA XVI

GELAR TEKNOLOGI KIMIA

KELUARGA MAHASISWA TEKNIK KIMIA
PROGRAM STUDI TEKNIK KIMIA FAKULTAS TEKNIK
UNIVERSITAS MUHAMMADIYAH SURAKARTA
Sekretariat : Gedung F Lt. 1 Sayap Utara Fakultas Teknik Kampus 2 UMS
Jl A.Yani Pabelan Tromol Pos 1 Surakarta 57102 087858342341 http:kmtk.ums.ac.id
FORMULIR PENDAFTARAN PESERTA LKTI Gelar Teknologi Kimia XVI 2015
Pengembangan Inovasi Teknologi Tepat Guna dan Energi Terbarukan

Detail Abstrak
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NIM

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Angkatan

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Alamat Rumah

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Biodata Diri
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NIM

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T/TL

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KOORDINATOR OLIMPIADE KIMIA SMA XVI

GELAR TEKNOLOGI KIMIA
KELUARGA MAHASISWA TEKNIK KIMIA
PROGRAM STUDI TEKNIK KIMIA FAKULTAS TEKNIK
UNIVERSITAS MUHAMMADIYAH SURAKARTA
Sekretariat : Gedung F Lt. 1 Sayap Utara Fakultas Teknik Kampus 2 UMS
Jl A.Yani Pabelan Tromol Pos 1 Surakarta 57102 087858342341 http:kmtk.ums.ac.id
Alamat Rumah

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Biodata Diri
Nama Lengkap

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Universitas

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Jabatan dalam kelompok

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NIM

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Angkatan

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T/TL

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Alamat Rumah

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Kontak Khusus Ketua

E-mail
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No. HP

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Dengan ini saya menyatakan bahwa data ini saya buat dengan sebenar-benarnya, Apabila
sewaktu proses seleksi maupun olimpiade berlangsung ditemukan kesalahan dengan data
tersebut, maka panitia berhak melakukan tindakan selektif untuk memastikan data peserta
yang terdaftar adalah benar dan siap untuk berkompetisi dalam Olimpiade Kimia (Gelar
Teknologi Kimia XVI) Teknik Kimia Universitas Muhammadiyah Surakarta tahun 2015.
...............,.................................2015
PESERTA LKTI GTK XVI
TEKNIK KIMIA UMS 2015
(Nama Terang)