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UNIVERSITAS PADJADJARAN

LINGKUNG SENI SUNDA

BALE RANCAGE XXXII Komplek UKM Barat Universitas Padjadjaran. Jl. Raya Jatinangor KM 21, Sumedang Telp.

(022) 7782020 E-mail: kontaklises@gmail.com

BIODATA PAMILON BALE RANCAGE XXXII

LINGKUNG SENI SUNDA UNIVERSITAS PADJADJARAN

Data Pribadi Wasta : __________________________________________________________ Nénéhan : __________________________________________________________ Kaping Dibabarkeun : __________________________________________________________ Fakultas/Jurusan : __________________________________________________________ NPM : __________________________________________________________ Padumukan di Bandung/ : __________________________________________________________

Jatinangor __________________________________________________________ No. Telepon : __________________________________________________________ Alamat Libur : __________________________________________________________

__________________________________________________________ No Telepon : __________________________________________________________ Kalanggenan : __________________________________________________________ Data Sepuh / Wali

Jenengan : __________________________________________________________ Padamelan : __________________________________________________________ Kalungguhan : __________________________________________________________ Padumukan : __________________________________________________________ Kaparigelan dina Widang Seni Kantos Ngiringan Kagiatan Kasenian:

1. ………………………………………………………. di .................................................. taun............... 2. …………….………………………………………… di .................................................. taun............... 3. ………………………………………………………. di .................................................. taun............... 4. ……………………………………………….……… di .................................................. taun............... Pangajen dina Widang Seni anu Kantos Dicangking : 1. ………………………………………………………. di .................................................. taun............... 2. …………….………………………………………… di .................................................. taun............... 3. ………………………………………………………. di .................................................. taun............... 4. ……………………………………………….……… di .................................................. taun............... Pangalaman dina Widang Organisasi 1. ………………………………………………………. di .................................................. taun............... 2. …………….………………………………………… di .................................................. taun............... 3. ………………………………………………………. di .................................................. taun............... 4. ……………………………………………….……… di .................................................. taun...............

Jatinangor, ….......…………….... 2015

________________________ NPM .

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