FORMULIR KOMUNITAS CALON PESERTA NAMA : ........................................................... ............................................ KOMUNITAS ALAMAT : .................................................. ...................................................... SEKRETARIAT ............................................ ............................................................ TELEPON : ................................................. ...................................................... EMAIL : ................................................. ...................................................... FACEBOOK/ : ................................................. ...................................................... TWITTER NAMA KETUA : ........................................................... ........................................... CONTACT PERSON : ........................................................... ........................................... JUDUL TARIAN : ........................................................... ........................................... KOREOGRAFER : ........................................... .......................................................... DAFTAR NAMA ANGGOTA KOMUNITAS YANG AKAN MENGIKUTI KEGIATAN : NO. NAMA ANGGOTA TEMPAT LAHIR TANGGAL LAHIR CONTACT PERSON KETERANGAN (PENARI/
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FORMULIR KOMUNITAS CALON PESERTA
NAMA : .......................................................................................................
KOMUNITAS
ALAMAT : ........................................................................................................
SEKRETARIAT ........................................................................................................
TELEPON : .......................................................................................................
EMAIL : .......................................................................................................
FACEBOOK/ : .......................................................................................................
NAMA KETUA : ......................................................................................................
CONTACT PERSON : ......................................................................................................
JUDUL TARIAN : ......................................................................................................
KOREOGRAFER : .....................................................................................................
DAFTAR NAMA ANGGOTA KOMUNITAS YANG AKAN MENGIKUTI KEGIATAN :
NO. NAMA ANGGOTA TEMPAT LAHIR TANGGAL LAHIR
CONTACT PERSON
KETERANGAN(PENARI/TIM PRODUKSI)
1.2.3.4.5.6.7.8.9.
10.11.12.13.14.15.
.......................,...................... 2013
PENGALAMAN MENTAS TARI SELAMA 5 TAHUN TERAKHIR
WAKTU PELAKSANAAN
NAMA PERTUNJUKAN
JUDUL TARIAN KOREOGRAFER
PRESTASI PERTUNJUKAN TARI SELAMA 5 TAHUN TERAKHIR
WAKTU PELAKSANAAN
NAMA PERTUNJUKAN
JUDUL TARIAN KOREOGRAFER PRESTASI YANG DI RAIH
TIM PRODUKSI/KEPANITIAAN KOMUNITAS DALAM MENGIKUTI VARIASI 2013
NAMA ANGGOTA NOMOR ANGGOTA JABATAN/POSISI DI KEPANITIAAN
FORMULIR ANGGOTA KOMUNITAS CALON PESERTA
NAMA : ....................................................................
TEMPAT/TANGGAL LAHIR : ....................................................................
ALAMAT : ....................................................................
: ....................................................................
EMAIL : ....................................................................
FACEBOOK : ....................................................................
CONTACT PERSON : ....................................................................
POSISI DALAM TIM PRODUKSI : ....................................................................
Ketua komunitas Anggota komuitas
Nama terang Nama terang
nomor pokok mahasiswa nomor pokok mahasiswa
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