Registration Form

Department of Chemical Engineering

Faculty of Industrial Techology
Sepuluh Nopember Institute of Technology
Sukolilo, Surabaya, Indonesia
Tel : 31-5946240 Fax : 03-5999282

Team Title :
University :
7th INDONESIA CHEM_E_CAR COMPETITION 2018
Name of the
Institution :
(University / College)
Address :
Name of Team :
Team Leader :
Team Members :
:
:
:
Name of Manager :
Name of Advisor /
:
Supervisor
Tel. Number :
Fax. Number :
e-Mail Address :

JSA
Please include Student Identity Card Scan
documents of Complete Contact Information of
the following Participants and Manager
Declaration Letter
7th INDONESIA CHEM-E-CAR COMPETITION
CHERNIVAL 2018
1
 Link of car’s Video

Deadline: February 04th, 2018 Signature :

...............................................

7th INDONESIA CHEM-E-CAR COMPETITION

CHERNIVAL 2018
2