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Nama
(lengkap dengan gelar)
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Instansi
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Alamat
Korespondensi
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Telepon.........................................
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Faksimilie.....................................
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E-mail............................................
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Berminat
mengikuti SRKP 2004
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Sebagai
Peserta
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Menyajikan
Makalah
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(judul
dan abstrak terlampir)
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Biaya
Pendaftaran sebesar Rp. ...........
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Transfer
No. Rek. 261.010035471.901
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BNI
1946 Cab. Undip a.n. Nanik-Seminar
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Dibayar
langsung di Sekretariat Panitia
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pada
saat seminar
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