7/22/2019 Form Kosong Pendaftaran Ssci Baru

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FORMULIR PENDAFTARAN ANGGOTASUZUKI SPLASH CLUB INDONESIA (SSCI)

Mailing List:SUZUKISPLASHCLUBID!"AHOOGROUPS#COM

http://www.facebook.com/group.php?gid=106301382734075

DATA ANGGOTA (#a) TATA CARA PENDAFTARAN SSCI (#$)

NAMA : Muhammad khoiril anwar %# M&l&ng'ai $ata a$a *+, ini $an ,&ngi+i,'an -ia &,ail '&

:

.# Bagi angg*ta +&s,i SSCI/ a'an ,&n$aat'an :

%0 Ka*s +&s,i SSCI

C1tting sti'&+ SSCI 1nt1' 'a0a $&an $an 2&la'ang Ka+t1 Tan$a Angg*ta SSCI

M&n$aat'an s&sial $is0*1nt $i ,&+03ant +&'anan

3. 4# No Rekening SSCI:Bank : BCA KCP WTC SudirmanNoRek : 5455 330022a/n ann! Ra"man Amri#a$

SEX : Pri

NO HP : 081252864027

PN !!EMA"

::

#1#52$%7kailkoiku&'ahoo()om

*A + ,M - : .

//AN !A/ :

DATA ANGGOTA (#2)3EMPA3 "AH : /un Pandan

3ANA" "AH : 14 Mi 1%82

S3A3/S : !lum awin

A"AMA3 /MAH : l( a9rian E.11

PEEAAN : Swa9a

A"AMA3 AN3O : l( Sunandar Pri'o Sudarmo no( 18

HO!!, : Makan

DATA MOBIL SPLASH (#0)

NOMO PO"S : N 1287 !A

*ANA : Mrah3ANSMS : MAN/A"

NO MESN : 12MN700#587

NO ANA : MA#X!72S!0#00677

3H PEM!/A3AN : 2011

MASA !E"A/ S3N : 28 uli 2016

E,ail t* : &n$ata+an#ss0i!g,ail#0*,S125&0t : F*+, &n$ata+an SSCI 6 7NO POLISI8

mailto:SUZUKI-SPLASH-CLUB-ID@YAHOOGROUPS.COMmailto:SUZUKI-SPLASH-CLUB-ID@YAHOOGROUPS.COMhttp://www.facebook.com/group.php?gid=106301382734075mailto:SUZUKI-SPLASH-CLUB-ID@YAHOOGROUPS.COMhttp://www.facebook.com/group.php?gid=106301382734075