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Poliban English Community Registration Form
Online form for register to Poliban English Community
If you can't use this form you can ask for hard copy of this form, contact your English lecturer
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* Indicates required question
Full Name
*
Write your full name here
Your answer
Nick Name
Write your nick name here
Your answer
NIM
*
ex: E03110095
Your answer
Department / Class / Semester
*
Enter your Department, Class and Semester
Your answer
Date of Birth
*
ex: 25 of December 1993
Your answer
Phone Number
*
Enter your phone number, it's important for us to contact you
Your answer
E-mail address
enter your e-mail address
Your answer
Hobby
Tell us your hobby
Your answer
Who are you?
*
Tell us about you and yourself
Your answer
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