STAFF REGISTRATION FORM SOCIETY OF ECONOMIC GEOLOGISTS

SC UNPAD 20151ST Choice : 2nd Choice : Unwanted division : (Fill Required)

DATA DIRIFull Name :NPM:Place and Date of Birth :Gender :Religion :Phone number :E-mail:Adress:Motto:

ORGANIZATION EXPERIENCEORGANIZATION POSISITION PERIOD

COMMITTEE EXPERIENCEEVENT POSISITION YEAR

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STAFF REGISTRATION FORM SOCIETY OF ECONOMIC GEOLOGISTS

SC UNPAD 2015DIVISION OPTION

1. Division :

Motivation :

2. Division :

Motivation :

If you have to be transferred to another division, youwill not be transferred into the following divisions:3. Unwanted Division :

Reason :

SEG Division : Head DivisionCourse and Workshop : Renanda SevirajatiFieldtrip : Md Fathan MauludinResearch : AlisahHuman Resource Development (HRD) : Shine PurbaOrganization Development (OD) : Simon Ananda SianiparPublic Relation (PR) : Yolla BudianaMedia : Titip AnillahiFund Raising : M Randy Nugraha

* The opening of the registration division staff of the Society of Economic Geologists SC UNPAD is starting from January 17, 2015 and closed on 24 January 2015. Forms can be mailed to scseg_unpad@yahoo.com . If up to the last date have not submitted the registration form , the placement of the division will be made at the discretion of the President , Vice President and Head Department SEG SC UNPAD.

Regards,Thank You.