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FORMULIR PENDAFTARAN
BEST RESEARCH AWARDS
Informasi Peserta
Nama
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Alamat
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Bidang Ilmu/penelitian yang diajukan:
Obat/Sediaan Obat
(Bioteknologi, Kimia Medisinal, Kimia Bahan Alam, Teknologi Farmasi)
Diagnostik/Metode pengobatan
Pangan Fungsional (yang terkait dengan kesehatan)
Judul Penelitian: ...........................................................................................................................
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Lampiran
1. Curriculum Vitae…………………………………………………………………….
2. Ringkasan Penelitian yang dinonimasikan ......................................................
3. Full paper penelitian yang dinominasiakan .....................................................
4. Foto 4 x 6 dan 3R............................................................................................
....................., ..................................., 2014
Cap dan Tanda Tangan
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