User account

Dear Mbako/mbaki, please fill this form completely. Be sure that every information is correct, especially your FULL NAME and DEPARTMENT. We will check your information against ITB98 database. Any inconsistencies may results on disapproval on your request.

Account information

Username: *

Your preferred username; punctuation is not allowed except for periods, hyphens, and underscores.

E-mail address: *

A valid e-mail address. All e-mails from the system will be sent to this address. The e-mail address is not made public and will only be used if you wish to receive a new password or wish to receive certain news or notifications by e-mail.

Contact Information

Address:

Well, we know that alumni of ITB move a lot. But at least tell us your current address. You will always be able to change it later. Don't worry, your address will not be published. The content of this field is kept private and will not be shown publicly.

Phone number (fixed):

The content of this field is kept private and will not be shown publicly.

Mobile Phone:

Please tell me your mobile phone, especially if you are interested in becoming a donor. So that ITB98 team can inform you any updates about the program. The content of this field is kept private and will not be shown publicly.

ITB98 Scholarship Program

Yes, I heard about ITB98 Scholarship program

The content of this field is kept private and will not be shown publicly.

Yes, I am interested in becoming donor for ITB98 Scholarship Program

If you interested, please check the box (Psst... If you curious, it's only Rp 50.000,00 per month). We will inform you any update about the program. To ease our communication, please fill out your phone number and email.

The content of this field is kept private and will not be shown publicly.

Memories in ITB

Department: * AstronomiBiologiDesain GrafisDesain InteriorDesain Komunikasi VisualDesain ProdukFarmasiFisikaKimiaMatematikaMeteorologiOseanografiPlanologiSeni KriaSeni RupaTeknik ArsitekturTeknik ElektroTeknik FisikaTeknik GeodesiTeknik GeofisikaTeknik GeologiTeknik IndustriTeknik InformatikaTeknik KelautanTeknik KimiaTeknik LingkunganTeknik MaterialTeknik MesinTeknik PenerbanganTeknik PerminyakanTeknik PertambanganTeknik Sipil

Your department in ITB

NIM:

Student's Index Number (a.k.a Nomor Induk Mahasiswa)

Serikat OSKM:

Hmm... Do you still remember those 'happy' days...? ;)

Personal Information

Full name: *

Homepage/blog:

Do you have a personal homepage or blog? Don't be shy... Let's share it WARNING: please include "http://". Fill it like this "http://itb98.blogspot.com". Not just "itb98.blogspot.com"

Nickname:

Your nick name, on-air name, 'gaul' name, or anything that used to be used by your friends to identify yourself

Status:

Yup, it means your marriage status. It is important, because we need to know, how many ITB98 married as scheduled :p

Birth date: *

JanFebMarAprMayJunJulAugSepOctNovDec

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Come on, tell me your birth date. Or, are you affraid if we throw you to the "Sinking Indonesia" Pool at ITB? :p The content of this field is kept private and will not be shown publicly.

Birth place:

The content of this field is kept private and will not be shown publicly.

Professional Information

Company Name: *

Your company where you work, or may be your own company!

Job Title: *

What do you do in your company?

Company Address:

The address of your company

City: *

Country: * AfghanistanAland IslandsAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCanadaCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoDemocratic Republic of theCook IslandsCosta RicaCôte d'IvoireCroatiaCubaCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEast TimorEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorthern Mariana IslandsNorth KoreaNorwayOmanPakistanPalauPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarReunionRomaniaRussiaRwandaSaint HelenaSaint Kitts and NevisSaint LuciaSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSerbia and MontenegroSeychellesSierra LeoneSingaporeSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth KoreaSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUnited States minor outlying islandsUruguayUzbekistanVanuatuVatican CityVenezuelaVietnamVirgin IslandsBritishU.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabwe

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