Formulir Baksos Apt Xx

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  FORUM MAHASISWA PROFESI APOTEKER  PROGRAM STUDI PROFESI APOTEKER FAKULTAS FARMASIUNIVERSITAS JENDERAL ACHMAD YANIJl. Terusan Jenderal Sudr!an PO O# $%& C!a'Gedun( La)*ra+*ru! Fa,ul+as MIPA l+. - Fa,ul+as Far!asTel. /0--1 223$4&$ C!a'5 -4 Januar -0$2 N* 6 0$$7 P8Pen9ulu'an7 Pr*:es A+7 I7 -0$2Per'al6 Permohonan Bantuan Kegiatan La!ran6 - Le!)ar Keada Y+'. Alumni Farmasi UNJANI dTe!a+Den(an '*r!a+5Dala! ran(,a ela,sanaan sala' sa+u r*(ra! ,er;a !a'as<a r*:es a*+e,er ##UNJANI se,al(us se)a(a ers9ara+an ,elulusan5 !a,a ,a! )er!a,sud un+u, !en(ada,an ,e(a+an Pen9ulu'an Kese'a+an dan ala Pen(*)a+an Mas9ara,a+ 9an( a,andla,sana,an ada 6Har6 Ra)u dan Mn((uTan((al6 $0 dan $% Fe)ruar -0$2=a,+u6 Pu,ul 0>.00 =I ? selesa en+u, ,e(a+an6 Pen9ulu'an Kese'a+an dan ala Pen(*)a+an Mas9ara,a+Te!a+6 $. Pen9ulu'an d SMAN 4 C!a' dan Kelura'an C)e)er5Ke@a!a+an C!a' Sela+an5 K*+a C!a'-. ala en(*)a+an d Desa Pa+en(an Ke@. Ran@a)alKa! sela,u an+a !en(a;u,an er!*'*nan d*nas dan !en(a;a, seluru' Alu!nFar!as UNJANI un+u, )ereran ser+a dala! ,e(a+an ,a!. Ke(a+an n a,an!endaa+,an ser+:,a+ den(an nla % SKP. De!,an sura+ er!*'*nan n ,a! sa!a,an5 a+as er'a+an dan )an+uann9a ,a!u@a,an +er!a,as'. Hormat ami!Ketua PelasanaBam ang Ir#antoNIM$ %%&''&'(&%SeretarisAstri A#alia Ul)ahNIM$ %%&''&'''*Mengetahui!Ketua AlumniFarmasi UNJANIFai+al Hermanto! S$Si$! M$Si$! A,tNI-$ .'*' /*' 0* C 6 Les+ar Nur U+a! /0&$&0-000>031Lls Su!nar /0&3&-003-24-1  FORUM MAHASISWA PROFESI APOTEKER  PROGRAM STUDI PROFESI APOTEKER FAKULTAS FARMASIUNIVERSITAS JENDERAL ACHMAD YANIJl. Terusan Jenderal Sudr!an PO O# $%& C!a'Gedun( La)*ra+*ru! Fa,ul+as MIPA l+. - Fa,ul+as Far!asTel. /0--1 223$4&$ 1EMBAR KETERSE-IAAN BERPARTISIPASI Se+ela' !e!ela;ar r**sal n5 !a,a ,a! ,u+ )erar+sas se)a(a d*na+ur dala! ,e(a+an a,+ S*sal A*+e,er ## 6 Na!a6 .Ala!a+6 .Tel*n6 .FaB6 Ju!la' Par+sas6 Ka+e(*r 6 Cara Pe!)a9aran6 $. an, CA N*. Re, %3>$2$$%&$A.n Nada Da!aran9-. an, Mandr N*. Re, $3-8008$-0&08-A.n Adnda C. P.De!,an :*r!ulr ,e+ersedaan )erar+sas n ,a! )ua+ den(an )enar5 dan e!)a9aran a,an ,a! la,u,an sela!)a+8la!)a+n9a +an((al 6 .....H*r!a+ ,a!5...5  -0$2... Na!a Len(,a /1 8 Da:+ar *)a+ +erla!r 8 Te!a *s+er d+en+u,an an+a N 6 Se+ela' ds5 !*'*n d,r! !elalu e!al de::-20-3(!al.@*! a+au !en('u)un( CP.C 6 Les+ar Nur U+a! /0&$&0-000>031Lls Su!nar /0&3&-003-24-1 Trans:erTuna Uan( senla R. $40.0000 dan *s+erO)a+ senla R.$40.000  FORUM MAHASISWA PROFESI APOTEKER  PROGRAM STUDI PROFESI APOTEKER FAKULTAS FARMASIUNIVERSITAS JENDERAL ACHMAD YANIJl. Terusan Jenderal Sudr!an PO O# $%& C!a'Gedun( La)*ra+*ru! Fa,ul+as MIPA l+. - Fa,ul+as Far!asTel. /0--1 223$4&$ -AFTAR OBAT -AN BAHAN ME-IS 2AN3 -IBUTUHKANNoNama Jumlah 4i utuhanKet$ $.-.3.%.4.2.>.&..$0.$$.$-.$3.$%Te+es !a+a Erla!9@e+n Sale !a+a Erla!9@e+nTe+es +eln(a Erla!9@e+nCe+rne $0!(Ter!a(*n :*r+e +a). /PCT 240 !(1ISDN 4 !(D*!erd*ne susens Na8D,l*:ena, 40 !(I)ur*:en sruRan+dnCaleB sruSusens n@La@+* Te+es !a+a r+as rn(an-0 )*+*l-0 +u)e$0 )*+*l40 s+r40 s+r30 s+r40 )*+*l34 s+r40 )*+*l40 s+r-4 )*+*l$0 )*+*l- a@s$0 )*+*lO)a+O)a+O)a+O)a+O)a+O)a+O)a+O)a+O)a+O)a+O)a+O)a+O)a+*)a+ C 6 Les+ar Nur U+a! /0&$&0-000>031Lls Su!nar /0&3&-003-24-1
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