Formulir Sry Fix
Formulir Sry Fix
Formulir Sry Fix
Agama : Katolik.................................................................................................
No Telepon/ HP : 0852-7773-3004/0812-6532-7764.......................................................
E-mail : [email protected]................................................................................
Media : Komsoskam.com.................................................................................
Alamat Kantor : Jl. Mataram No.21, Petisah Hulu, Kec. Medan Baru, Kota
Medan, Sumatera Utara 20152.............................................................................................................
Demikian pengisian formulir ini diperbuat dengan sebenar-benarnya dan dipergunakan untuk
kepentingan pendaftaran calon anggota AJI Medan
Nama : …………………………..................................…………….
Media : ……………………………..................................………….
Alamat : ……………………………...................................………….
Nama : ………………………………....................................……….
Media : ………………....................................……………………….
Alamat : ……………....................................………………………….
Catatan :
Medan, ............................................
(..................................................)