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MX King Owner Club Solo

FORMULIR PENDAFTARAN

No Registrasi :

Nama Lengkap : ..................................................................................


No Identitas (KTP/SIM/Pelajar) : ..................................................................................
Tempat/Tanggal Lahir : ..................................................................................
Golongan Darah : ..................................................................................
Jenis Kelamin : ..................................................................................
Status Keluarga : ..................................................................................
Alamat Rumah : ..................................................................................
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Telepon/HP : ..................................................................................
Plat Nomor Kendaraan : ..................................................................................
Nomor STNK : ..................................................................................
Warna Dasar Motor : ..................................................................................

DENGAN INI MENYATAKAN BERGABUNG DENGAN MX KING OWNER CLUB


SOLO, DAN SIAP MENTAATI PERATURAN ORGANISASI.

Surakarta, .................... 20.....

3X4

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