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Formulir Pendaftaran KBRao
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Nama Lengkap
*
Contoh : Budi Hartono
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Nama Panggilan
*
Contoh : Budi
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Nomor Handphone
*
Contoh : 087895902242
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Nama & Nomor Rekening [ BCA/BNI/Mandir/BRI ]
*
Contoh : Budi Hartono BNI : 123456789
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Alamat E-Mail
*
Contoh :
csblograo@gmail.com
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Alamat Facebook
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Contoh :
http://facebook.com/csblograo
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Status
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Siswa
Siswi
Mahasiswa
Mahasiswi
PNS
Wiraswasta
Tani
Lainnya
Darimanakah Anda Mendapatkan Informasi KBRao ?
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Contoh :
http://komunitasblograo.blogspot.com/
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Bagaimankah Pendapat Anda Mengenai Program Ini ?
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Sangat Bagus
Bagus
Biasa
Jelek
Alamat Lengkap
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Contoh : Kejorongan, Kenagarian, Kecamatan, Kabupaten, Provinsi, Negara
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Pesan & Masukan Anda Mengenai Program Ini!
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Contoh : Kritik, Saran, Keluhan, Komentar
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