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Past, current and future campus activities:

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Mid Semester Test
Date: 7 November 2011

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Practice Test at RSUD
Date: 29 December 2011


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Saturday, 29 November 2014
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ONLINE REGISTRATION FORM

Notes:
  1. Body height and weight will be taken again at the registration counter at the campus.
  2. Remit admission fee to:
    Bank Panin acc. no. 5205043998 a/n Yayasan Pendidikan Payung Negeri
    Bank BRI acc. no. 0170-01-058179-50-7 a/n Ahmad Kurnia
  3. Registration fee is Rp.200.000,- (one choice) or Rp.250.000,- (two choices)
  4. Please email your bank transfer receipt to: info@payungnegeri.ac.id
  5. Registration is completed and accepted when you have sent us the bank transfer receipt.

Field with * is required

Faculty/School : - S1. Keperawatan
- S1. Kesehatan Masyarakat
- D.III Kebidanan
- D.III Keperawatan
* First Choice :
Second Choice (optional) :
* Full Name :
* Gender : Male Female
* Gender :
* Marital Status : Married Not Married
Body Height : cm
Body Weight : kg
* Place and Date of Birth : ,
* Address :
   
Phone :
* Handphone :
Postal Code :
* City :
* Email :
* School of Origin :
* Major :
* Nationality :
Photo :