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FORM PENDAFTARAN CWCN 13
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Tulis Nama (Untuk di Sertifikat)
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Your answer
Tempat & Tanggal Lahir
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Your answer
Alamat Domisili / Surat Menyurat
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Your answer
Nomer HP/WA
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Your answer
Agama
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Islam
Kristen
Katholik
Hindu
Budha
Kong Hucu
Alamat Email
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Your answer
Pendidikan Terakhir
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S2/S3 Keperawatan
Lulus Profesi ners
Lulus S1 Keperawatan
Lulus D3 Keperawatan
Asal Institusi Saat ini
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Your answer
Referensi (asal informasi)
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Instagram
Facebook
Flyer / brosur
Website PLC
Surat/Email Undangan
Alumni PLC
Other:
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Pembayaran Investasi
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Transfer Rp. 10.500.000
Transfer Rp. 13.750.000
Other:
Persyaratan yang harus disiapkan
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Foto (latar merah) 3 x 4 = 2 lbr
Foto (latar merah) 4 x 6 = 2 lbr
Fotocopy Ijazah pendidikan Keperawatan 1 lembar
Fotocopy STR / Surat tanda pengurusannya
Bukti Pembayaran Pelatihan
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