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  • Form Cassiiopeia SBY KLOSS

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    Efa Imama Nur Maulina
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    5 views1 page

    Form Cassiiopeia SBY KLOSS

    Uploaded by

    Efa Imama Nur Maulina

    Copyright:

    Attribution Non-Commercial (BY-NC)
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    FORMULIR PENDAFTARAN MEMBER

    KOMUNITAS CASSIOPEIA SURABAYA


    PERIODE TAHUN 2011
    GROUP : cassiopeia.surabaya@groups.facebook.com Email : cassiopeia.surabaya@yahoo.com

    Nomor KTP* Nomor ID KLOSS Nama Foto uk.4X6

    : : :

    Tempat, Tanggal Lahir : Alamat Asal No. HP Email : : : : : : : : : :

    Facebook Twitter Suka DBSK sejak Member Favorit Lagu Favorit Kesan pertama tentang DBSK

    Harapan untuk Komunitas Cassie Surabaya

    Kritik dan Saran untuk Cassiopeia Surabaya :

    Note: *) apabila tidak ada KTP bisa diganti dg SIM/ Kartu Pelajaratau kartu tanda pengenal lainnya

    Keterangan Lebih Lanjut : ---Deshinta 08563432707---Liandra 08385716099--Form harap dikirim ke uknowlian90@yahoo.com

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