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Pendaftaran Lari 10K & 5K
10 K UMUM (PODIUM 1-10 * HANYA UNTUK UMUM PUTRA)
5 K PELAJAR (PODIUM 1-5 PUTRA, PODIUM 1-5 PUTRI)
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Ds. Watugaluh Kec. Diwek Kab. Jombang
Kategori Lomba
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10 K Umum
5 K Pelajar Putra
5 K Pelajar Putri
Nama Peserta
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No ID Pelajar *Khusus Pelajar
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No KTP / SIM
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Tempat Lahir
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Tanggal Lahir
MM
/
DD
/
YYYY
No Hp
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Alamat
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Gol Darah
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No HP Emergency yang bisa dihubungi
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Perhatian
Setelah registrasi Berhasil,
Harap melanjutkan ke proses pembayaran / Transfer Kurang Dari 2 x 24 Jam
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