JPC UNESA - HOME
FORMULIR PENDAFTARAN
LOMBA UMUM
JAPAN POP CULTURE 2020
• JENIS LOMBA (pilih salah satu)
| |Dance Cover | |Desain Character |
| |Cosplay Competition | |Chiisai Manga |
| |Karaoke | | |
|Kategori (pilih salah satu) |
| |Tim/Duet | |Individu |
• JENIS SPESIAL PERFORMANCE (pilih salah satu)
| |Band | |Wotagei |
• Data Peserta (lewati jika mengikuti lomba kelompok)
|Nama Lengkap | |
|Tempat, Tanggal Lahir | |
|Alamat Tinggal | |
|No.Telpon/HP | |
|Email | |
• Data Tim
|Nama Tim | |
|Alamat (Basecamp)*** | |
|Nama Instansi | |
|Official*** | |
|No.Telepon Official*** | |
|Email Official*** | |
|Genre Musik***) | |
|Judul Lagu ***) | |
***Diisi apabila ada
***)Untuk peserta special performance wajib diisi
• Nama Anggota Tim (Official tidak dihitung)
|No. |Nama Anggota |No. |Nama Anggota |
|1. | |7. | |
|2. | |8. | |
|3. | |9. | |
|4. | |10. | |
|5. | |11. | |
|6. | |12. | |
• Data Pembayaran (Diisi jika membayar melalui transfer)
|No. Rekening | |
|A.N | |
|Nama Bank | |Tanggal** | |
|Nominal** | |Pukul** | |
**Diisi oleh panitia
Surabaya,………………………2020
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