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Kuesioner Usulan Buku Perpustakaan Tenas Effendy (Dinas Perpustakaan dan Kearsipan Kota Pekanbaru)
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Nama
*
Isi dengan nama lengkap
Your answer
Jenis Kelamin :
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Laki-laki
Perempuan
Nomor HP/WA
*
Your answer
Nomor Induk Kependudukan (NIK)
Boleh untuk tidak diisi
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Range Usia
*
Anak-anak (6 sd 11 tahun)
Remaja Awal (12-16 tahun)
Remaja Akhir (17-25 tahun)
Dewasa Awal (26-35 tahun)
Dewasa Akhir (36-45 tahun)
Lansia Awal (46-55 tahun)
Lansia > 55 tahun
Alamat
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Sertakan alamat RT/RW
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