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Formulir Bobotoh Riders Online
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NAMA LENGKAP
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NAMA PANGGILAN
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TEMPAT LAHIR
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TANGGAL LAHIR
MM
/
DD
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YYYY
MOBILE PHONE
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NO IDENTITAS
Isi kan No KTP/SIM/Kartu Pelajar/Kartu Mahasiswa
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ALAMAT LENGKAP
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TELPON RUMAH
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NAMA AKUN FACEBOOK
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PIN BB
Isikan PIN BB anda jika ada
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PAKET PENDAFTARAN
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Paket 1 KTA+Asuransi Rp 100.000
Paket 2 KTA+Asuransi+Kaos Rp 150.000
Paket 3 KTA+Asuransi+Rompi Rp 200.000
Paket 4 KTA+Asuransi+Jaket TASLAN Rp 225.000
Paket 5 KTA+Asuransi+Jaket Touring Rp 250.000
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