Formulir Serah Terima Honorarium Narasumber / Pemateri
DIKLAT TATA KELOLA PEMERINTAHAN DESA GELOMBANG I TAHUN 2021
Nama Lengkap
*
First Name
Last Name
NIP
Instansi / Lembaga
*
Jabatan
*
Eselon
Tanggal Ceramah
*
Please select a day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Day
Please select a month
January
February
March
April
May
June
July
August
September
October
November
December
Month
Please select a year
2021
Year
Judul Materi Ceramah
*
Alamat Email
*
example@example.com
No Whatsapp/ No Handphone
*
No Rekening Bank
*
Nama Bank
*
Nama sesuai Buku Tabungan
*
TANDA TANGAN
Selesai
Should be Empty: