Konfirmasi Pembayaran Peserta
Keterangan transfer *
Mohon tuliskan informasi berikut di sini: Tanggal transfer # Nama Bank # Nama Pemilik Rekening # Jumlah Transfer # Keterangan tambahan
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Nama Team *
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Nama Perguruan Tinggi *
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Nama Anggota 1 (contact person) *
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Email *
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Nomor Handphone *
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Ukuran Kaos *
Nama Anggota 2 *
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Email *
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Nomor Handphone *
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Ukuran Kaos *
Nama Anggota 3 *
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Email *
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Nomor Handphone *
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Ukuran Kaos *
Nama Coach (apabila hadir)
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Email
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Nomor Handphone
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Ukuran Kaos
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