Formulir Pendaftaran Lomba Batik Rumah Sakit Panti Rapih
Silakan mengisi formulir dibawah ini, untuk mengikuti Lomba Desain Batik dalam rangka HUT ke 90 Rumah Sakit Panti Rapih Yogyakarta.
Nama Lengkap *
Name
Your answer
Tanggal Lahir *
Birth of Date
MM
/
DD
/
YYYY
Alamat *
Your address
Your answer
Nomor Handphone *
phone number
Your answer
Nomor Whatsapp *
Whatsapp Number
Your answer
Pekerjaan/ Sekolah *
Occupation/ College
Your answer
Narasi Makna Desain Batik *
Naration about your design
Your answer
Submit
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