[fpdc] Registration_institut Pertanian Bogor_afwa Nururrahmah M.docx

REGISTRATION FORM FOOD PRODUCT DEVELOPMENT COMPETITION 2019 “Creating Novel Food Products Based on Local Resources to Promote SDGs” Paper Title University / City

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Author’s Identity Lead Author Name : Faculty/Major : Student’s Identity Number : Batch : Place/date of birth : Phone/E-mail : Address : Co-author 1 Name : Faculty/Major : Student’s Identity Number : Batch : Place/date of birth : Phone/E-mail : Address : Co-author 2 Name : Faculty/Major : Student’s Identity Number : Batch : Place/date of birth : Phone/E-mail : Address :

I hereby declare that all the information above is true. Lead Author, (sign)

(Name)

(Photo 3x4)

(Photo 3x4)

(Photo 3x4)

Attachment 1 Scans of Student’s Identity Card Lead Author

Co-author 1

Co-author 2

Attachment 2

ORIGINALITY STATEMENTS Paper Title

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Lead Author

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Co-author

: 1) ............................................................... 2) ...............................................................

We declare that the paper entitled above is an original work written by the authors and has not been published and or contested outside the “Food Product Development Competition 2019" organized by the HIMITEPA and supported by with SEAFAST Center and Department of Food Science & Technology IPB. Thus we make this statement in truth and if proven there is a breach in it, then we are ready to be disqualified from this competition as a form of our consequence.

………, .....………….. 2019 Lecturer,

Lead Author

(Name) NIDN. ……………………

(Name) NIM. ……………………