MENDAFTAR ANGGOTA

Cara Mendaftar Anggota Melilea

 

Untuk menjadi member Melilea, Anda dapat mengisi Formulir di menu Pra Pendaftaran  

Nama Lengkap Sesuai KTP              : ..........................................................................................

No KTP Terbaru                               : ..........................................................................................

TGl. Lahir (Tgl/bln/thn)                      : ..........................................................................................

Alamat Surat Menyurat (Termasuk
Kode Pos & Propinsi)                      : ..........................................................................................

E-mail                                              : ..........................................................................................

Nama Bank & No Rek Pendaftar       : ..........................................................................................

Hand Phone                                     : ..........................................................................................

Nama (Suami/Istri)                            : ..........................................................................................

No. KTP                                           : ..........................................................................................

Nama Ahli Waris & No KTP            : ..........................................................................................

Biaya Pendaftaran sebesar Rp. 55.000,-