ASOSIASI FASILITATOR KOPERASI INDONESIA

FORMULIR  KEANGGOTAAN

N a m a            : ..................................................................................................

Tanggal Lahir    : .......................................................................................................................

Pekerjaan         : 1. ...................................................................................................................

                          2. ...................................................................................................................

N.P.W.P.         : .......................................................................................................................

Alamat Kantor  ......................................................................................................................

                        ...............................................................................Telp./Fac ........................

Alamat Rumah  ..................................................................................................

                         ...............................................................................Telp./Fac ........................

No. Hp.           : .......................................................................................................................

Email               : .......................................................................................................................

Aktif di Koperasi               :

Nama Koperasi                 : .......................................................................................................................

Alamat Koperasi               : .......................................................................................................................

                                           ....................................................Telp./Fac ........................

Lembaga Diklat Profesi :

Nama LDP      : .......................................................................................................................

Alamat LDP    : .......................................................................................................................

                       ...............................................................................Telp./Fac ........................

Sertifikat Kompetensi Fasilitator :

Nomor Sertifikat              : .......................................................................................................................

Tanggal Sertifikat             : .......................................................................................................................

Unit Kompetensi              : .......................................................................................................................

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.........................., tanggal .............................

                                                                                                                Fasilitator KJK,

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