Formulir Pendaftaran Koi

 

Formulir Pendaftaran KOI ( Sample )

Formulir Pendaftaran KOI

Member ID                                            :  …………………………………… (diisi oleh Admin & Team KOI)                                                               

Data Personal                                                                                                                                                                                                                

User Name Forum Yang Ingin di Registrsaikan : ……………………………………. (bila belum registerasi pada forum)

Password Yang ingin Digunakan : …………………………………………………………… (bila belum registerasi pada forum)

Jenis Kelamin                          : ………………………………………………………………………….

Name  Lengkap                        :  ………………………………………………………………………..

Nama Pangilan                         : ………………………………………………………………………..

Tanggal Lahir                           : ………………………………………………………………………..

Alamat Rumah                         :  ………………………………………………………………………..

                                             :  ………………………………………………………………………..

                                             : Sumbar

Alamat Kantor                         :  ………………………………………………………………………..

                                             :  ………………………………………………………………………..

                                                                        :  Sumbar

Telepon

            Rumah                               :  ………………………………………………………………………..

            Kantor                                :  ………………………………………………………………………..

            Handphone                          :  ………………………………………………………………………..

            Fax                                    :  ………………………………………………………………………..

Agama                                           : ………………………………………………………………………..

Email                                            : ………………………………………………………………………..

Yahoo Messanger                             : ………………………………………………………………………..

Blackberry Messanger                       : ………………………………………………………………………..

Data Kendaraan Bermotor  

Merk Mobil  / Motor                         :

Type Mobil  / Motor                          :

Tahun                                              :

Warna                                              : 

No. Polisi                                        : 

No. Rangka                                      :

No. Mesin                                        : 

Alamat email yang Ingin dibuatkan       : …………………@koreamobil.com (Disk Space 3Mb)

Membership

Registration Fee Rp.100.000

KOI NETWORK

Korea Otomotif Indonesia – Komunitas Otomotif Indonesia                          

Jl. Tebet Barat Dalam IX No.25    Jakarta Selatan     12240                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                                         

Tlp. 021-32272900/68 Fax. 021-8376569

Korea Otomotif Indonesia - Komunitas Otomotif Indonesia

Rey Avena Auto Clinic

Jl. Taluak no.117, Jambu Air, Bukittinggi Sumatera Barat

Tlp. 07527027511 - 0752 9902117

 


Note :
Untuk pendaftaran dan pengisian formulir di harap langsuang ke sekretariat KOI Sumbar