Formulir Pendaftaran NCP
FORMULIR PENDAFTARAN PESERTA NON CALL PAPER
KONFERENSI NASIONAL HUKUM TATA NEGARA KE-4
10 – 13 NOVEMBER 2017
Nama
: ...................................................................................
Tempat/Tgl. Lahir
: ...................................................................................
Jenis Kelamin
: ...................................................................................
Alamat
: ...................................................................................
Institusi
...........
: ........................................................................
Nomor Telepon/HP/ Fax
: ...................................................................................
e-mail
: ...................................................................................
Pendidikan
1. ...................................................................................
2. ..................................................................................... dst
Penelitian
1. .....................................................................................
2. ......................................................................................dst
Karya ilmiah dan artikel yang pernah dipublikasi
1. ....................................................................................
2 .................................................................................... dst
Pengalaman menjadi narasumber dalam forum ilmiah
1. ....................................................................................
2. .................................................................................... dst
Dengan ini menyatakan diri bersedia menjadi peserta non call paper.*
.........................., ......................................... 2017
(....................................................................)
*Coret yang tidak perlu
NB :
1. Untuk peserta Non Call Paper (NCP) tidak mendapatkan fasilitas transportasi dan
akomodasi
2. Pendaftaran peserta NCP diterima paling lambat tanggal 13 Oktober 2017.
3. Pengiriman lembar form pendaftaran NCP dapat dikirimkan
email
:[email protected](
08553006000
[email protected]( 089656518870 )
melalui
)dan
KONFERENSI NASIONAL HUKUM TATA NEGARA KE-4
10 – 13 NOVEMBER 2017
Nama
: ...................................................................................
Tempat/Tgl. Lahir
: ...................................................................................
Jenis Kelamin
: ...................................................................................
Alamat
: ...................................................................................
Institusi
...........
: ........................................................................
Nomor Telepon/HP/ Fax
: ...................................................................................
: ...................................................................................
Pendidikan
1. ...................................................................................
2. ..................................................................................... dst
Penelitian
1. .....................................................................................
2. ......................................................................................dst
Karya ilmiah dan artikel yang pernah dipublikasi
1. ....................................................................................
2 .................................................................................... dst
Pengalaman menjadi narasumber dalam forum ilmiah
1. ....................................................................................
2. .................................................................................... dst
Dengan ini menyatakan diri bersedia menjadi peserta non call paper.*
.........................., ......................................... 2017
(....................................................................)
*Coret yang tidak perlu
NB :
1. Untuk peserta Non Call Paper (NCP) tidak mendapatkan fasilitas transportasi dan
akomodasi
2. Pendaftaran peserta NCP diterima paling lambat tanggal 13 Oktober 2017.
3. Pengiriman lembar form pendaftaran NCP dapat dikirimkan
:[email protected](
08553006000
[email protected]( 089656518870 )
melalui
)dan