Anda di halaman 1dari 1

IURAN ANGGOTA AIJ - periode 1 Januari - 31 December

2013
(30,- CHF per tahun)
Telah diterima iuran anggota sebesar :_________________________
Nama : ..............................................................................................................
Alamat rumah:..................................................................................................
..........................................................................................................................
Email : ..............................................................................................................
Telpon: .............................................................................................................

Tanggal...........................Di:............................
Tanda tangan:

(...........................................................)