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Pendaftaran Online Membership LAZIO INDONESIA
Silahkan isi form dibawah ini sebagai syarat menjadi member kami
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Nama Lengkap
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Tempat, Tanggal Lahir
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Alamat Lengkap
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Dilengkapi dengan regional LI asal dan bagi yang belum tergabung dalam regional bisa ditulis non regional
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No. Telp/Hp
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Email
*
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ID Jejaring Sosial
Contoh : Facebook dan Twitter
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No. ID Card
*untuk member lama
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