Formulir.docx

Registration Form IPTS English Competition III (IEC 3 ) 2018 Information Centre : English Department Office of IPTS, 1st Floor, 16 th room, close by BNI ATM

082165748388 ( The Committees of IEC III ) [email protected]

Competition Category

: 1. Speech Competition 2. Singing Competition 3. Story Telling Competition 4. TOEFL Olympiad 5. National Essay Competition

Name

:

Place, Date of Birth

:

School Level

: a. Senior High School b. High School / University

NIS / NPM

:

Phone Number

:

Email

:

School /Campus Address

:

............................., .................. 2018

Participant,

...................................................... NIS/NPM. NB: -

Telpon / HP yang dicantumkan mohon dipastikan bisa dihubungi untuk mempermudah konfirmasi.