STMIK BUMIGORA Website : www.stmikbumigora.ac.id Email : [email protected]

FORM REGISTRASI Pelatihan: CCNA Exploration 1 Fast Track (Network Fundamentals) CCNA Exploration 2 Fast Track (Routing Protocols & Concepts) CCNA Exploration 3 Fast Track (LAN Switching & Wireless) CCNA Exploration 4 Fast Track (Accessing the WAN) MTCNA (MikroTik Certified Network Associate)

Microsoft Action Program Workshop Cisco Connection ID : ______________________ (bagi yang sudah memiliki) Biodata Peserta Nama Depan : __________________________________________ Nama Belakang : __________________________________________ Alamat : __________________________________________ Kota : __________________________________________ Propinsi : __________________________________________ Kode Pos : __________________________________________ Negara : __________________________________________ Telepon : __________________________________________ Fax : __________________________________________ Handphone : __________________________________________ Alamat Email : __________________________________________ Jenis Kelamin : __________________________________________ Tempat/Tanggal Lahir : __________________________________________ Instansi Nama Instansi : __________________________________________ Alamat Instansi : __________________________________________ Telepon : __________________________________________ Website : __________________________________________ Informasi tambahan untuk Mahasiswa/Alumni STMIK Bumigora Jenjang : S1 D3 D2 D1 Jurusan : Teknik Informatika Manajemen Informatika NIM : ________________

Mataram,

___________________________