Formulir Konfirmasi Donasi LTM Jatrova
Mohon mengisi data diri berikut sebagai bentuk konfirmasi pemberian donasi
* Required
Nama
*
Your answer
No. Hp
*
Your answer
Email
Your answer
Bentuk Donasi
*
Bank Baju Bekas
Dana Tunai
Partisipasi
Required
Program diikuti (pilihan)
*
Desa Harmoni
Generasi Mandiri
Warga Berdaya
Masyarakat Sehat
Kampung Agrikultur
Required
Sarana Kirim
*
Bank
Kargo
Jemput
Other:
Required
Nama Bank / Kargo
*
BCA
Pos
Other:
Required
Jumlah Dana
*
Your answer
Keterangan
Your answer
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