Registrasi

• Name*

  Prefix

  First Name

  Middle Name

  Last Name
• Gender*

  Female

  Male
• Profile Picture*
• Place of Birth*
• Date of Birth*
• Phone Number*

  eg. +628988025****
• Email*

  eg. xyz@domain.com
• NIM*
• Major*
• Program*

  D-I	D-III	D-IV
  PVB	Darmasiswa
• Campus*

  Taman Puring Pondok Cabe Sudirman Roxy Square LIPPO Cikarang Great Western (campus)
• Organizational Experience*
• Motivation for Joining FORKIS*
• Security Code*

   

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