[Form 1] Sign-up sheet

2017 International Student Car Competition

Sign-up sheet
I apply for participation in the International Student Car Competition hosted by the Korea Transportation Safety Authority and the
Korea Auto-Vehicle Safety Association, and sponsored by the Ministry of Land, Infrastructure and Transport Affairs.

GARUDA UNY Garuda Hybrid- No of

Team name Car name 13 persons
RACING TEAM 17 participants

Name of
representative SURATIJO Adviser name SUTIMAN, M.T.
AUTOMOTIVE ENGINEERING, FACULTY OF ENGINEERING, UNIVERSITAS NEGERI
Affiliation
YOGYAKARTA (UNY) / YOGYAKARTA STATE UNIVERSITY (YSU)
Address JALAKAN,RT 04, TRIHARJO, PANDAK, BANTUL, YOGYAKARTA ( - )

Representative
Phone - Cell phone +62857 8650 7525
suratijo.joe@gmail.com /
Fax - e-mail address suratijo353ft@student.uny.ac.id

Address GEDONGAN 003/027 SUMBERADI MLATI SLEMAN YOGYAKARTA ( - )

Adviser
Phone - Cell phone +62812 2766 540
sutiman@uny.ac.id /
Fax - e-mail address
timan_oto@yahoo.co.id
I confirm that the aforementioned is true, and all participants will comply with operating rules and safety rules of
the competition during the competition period, and make efforts to ensure mutual cooperation and friendship.

Attachment:
A copy of the entry fee (KRW200,000) online account transfer certificate

01 31 2017

Representative of the Team : SURATIJO

I recommend the aforementioned team for participation in the International Student Car Competition.

01 31 2016

Adviser : SUTIMAN, M.T

To the Chairman of the International Student Car Competition Organizing Committee

[Form 2] List of competition participants
List of competition participants
School name : Universitas Negeri Yogyakarta
Team name : Garuda UNY Racing Team
Adviser name : Sutiman, M.T.
Department Year Student number Name Duties

AUTOMOTIVE
2014 14504241024 SURATIJO REPRESENTATIVE
ENGINEERING

ENGLISH LANGUAGE KARTIKA

2015 15202244012 ADMINISTRATION
EDUCATION PERMATASARI

AUTOMOTIVE
2015 15504241006 I WAYAN YOGI ARTA ENGINE ENGINEER
ENGINEERING

AUTOMOTIVE ANDRI JANARKO

2013 13504241015 AUTOBODY ENGINEER
ENGINEERING PUTRO

AUTOMOTIVE STEERING BRAKE

2014 14504241007 IRMANTO
ENGINEERING SUSPENSION

AUTOMOTIVE
2015 1504244003 GEA LURUDANCANG AUTOMOTIVE DESIGNER
ENGINEERING

ELECTRONICS BUDIMAN SETYO

2015 15507134001 ELECTRICAL ENGINEER
ENGINEERING UTOMO

MECHANICAL ARDI MAULANA

2014 14508134025 CHASSIS ENGINEER
ENGINEERING MUBAROK

MECHANICAL ERWIN HANARI MACHINING AND

2014 14503244001
ENGINEERING SUBARNO CONSTRUCTION

AUTOMOTIVE
2014 14504244009 MIFTA SAPUTRA DRIVER
ENGINEERING

AUTOMOTIVE
2014 14509134003 MUSTAFIT SEPTIAN DRIVER
ENGINEERING
LECTURER OF
AUTOMOTIVE SUTIMAN, M.T. ADVISOR
ENGINEERING
LECTURER OF
DR. ZAINAL ARIFIN,
AUTOMOTIVE ADVISOR
M.T.
ENGINEERING
I submit the list of the prospective participants in the International Student Car
Competition according to operating rules.

01 - 31 , 2017

Team representative
SURATIJO

To the Chairman of the International Student Car Competition

Organizing Committee