Form Data Alumni

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IKATAN ALUMNI (IKA) PERGERAKAN MAHASISWA ISLAM INDONESIA (PMII)

( Branch Board of Indonesian Moslem Student Movement ) KABUPATEN OGAN KOMERING ILIR U-03 FORM DATA ALUMNI 1. Nama

: …………………………………………………………

2. Tempat, Tangal Lahir

: …………………………………………………………

3. Alamat

: ………………………………………………………… …………………………………………………………

4. Telp/ HP (WA)

: …………………………………………………………

5. E-mail

: …………………………………………………………

6. Cabang Asal

: …………………………………………………………

7. Jabatan

: …………………………………………………………

8. Jenjang Kederisasi

: ………………………………………………………… a. ……………………………………………………… b. ……………………………………………………… c. ……………………………………………………… d. ……………………………………………………… e. ………………………………………………………

9. Status Pekerjaan

: Sudah / Belum Bekerja *

10. Nama Kantor/Tempat Kerja

: ….......................................................................,

11. Jabatan

: ….……………………………………………..

12. Alamat Kantor

: …………………………………………………

NB:  Untuk (*) mohon di coret / hapus yang tidak perlu  Isian form data alumni digunakan untuk mendata alumni PMII yang ada di Kabupaten OKI.

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