Permohonan Ifi
This document was uploaded by user and they confirmed that they have the permission to share it. If you are author or own the copyright of this book, please report to us by using this DMCA report form. Report DMCA
Overview
Download & View Permohonan Ifi as PDF for free.
More details
- Words: 172
- Pages: 1
IKATAN FISIOTERAPI INDONESIA The Indonesian Physiotherapy Association FORMULIR REGISTRASI ANGGOTA IKATAN FISIOTERAPI CABANG PALEMBANG Sekretariat : Instalasi Rehabilitasi Medik RSUP Dr. Mohammad Hoesin Palembang Jl. Jend. Sudirman km. 3,5 Palembang Telp. (0711) 354088 ext. 408 – 409 Blog : ifi-palembang.blogspot.com
No. Registrasi
0
Nama
:
Tempat / Tanggal lahir
:
Alamat tempat kerja
:
0
6
0
/
I
F
I
......................................... Telp Alamat rumah
: ......................................... Telp
Pendidikan
:
DIII FT
:
lulus tahun ..................................................... Di ...................................................................
DIV FT
:
lulus tahun ...................................................... Di ...................................................................
S1 FT
:
lulus tahun ...................................................... Di ...................................................................
S2 FT
:
lulus tahun ...................................................... Di ...................................................................
Lain – lain (sebutkan) ...................................... Lulus tahun ........................................................ ...................................... Di ...................................................................... ...................................... Lulus tahun ........................................................ ...................................... Di ...................................................................... ...................................... Lulus tahun ........................................................ ...................................... Di ......................................................................
………………………………………… Pemohon
Catatan : Dibuat rangkap dua Data akan dimasukkan dalam database IFI Sebagai penentuan hak suara dan hak bicara anggota pada kongres Foto kopi ijazah fisioterapi Pas photo 2 x 3 cm dan 3 x 4 cm berwarna masing – masing 2 lembar
……………………………………
No. Registrasi
0
Nama
:
Tempat / Tanggal lahir
:
Alamat tempat kerja
:
0
6
0
/
I
F
I
......................................... Telp Alamat rumah
: ......................................... Telp
Pendidikan
:
DIII FT
:
lulus tahun ..................................................... Di ...................................................................
DIV FT
:
lulus tahun ...................................................... Di ...................................................................
S1 FT
:
lulus tahun ...................................................... Di ...................................................................
S2 FT
:
lulus tahun ...................................................... Di ...................................................................
Lain – lain (sebutkan) ...................................... Lulus tahun ........................................................ ...................................... Di ...................................................................... ...................................... Lulus tahun ........................................................ ...................................... Di ...................................................................... ...................................... Lulus tahun ........................................................ ...................................... Di ......................................................................
………………………………………… Pemohon
Catatan : Dibuat rangkap dua Data akan dimasukkan dalam database IFI Sebagai penentuan hak suara dan hak bicara anggota pada kongres Foto kopi ijazah fisioterapi Pas photo 2 x 3 cm dan 3 x 4 cm berwarna masing – masing 2 lembar
……………………………………
Related Documents
Permohonan Ifi
June 2020 12
Persyaratan Ifi
June 2020 17
Sebab Bank Ifi
June 2020 9
Ifi Intake Package
November 2019 33
Permohonan Insentif.docx
June 2020 19