No NAMA DEPAN NAMA BELAKANG MALE/FEMALE TANGGAL LAHIR TEMPAT LAHIR

1 DENNIS SHABRI ALFANI MALE 29/02/1992 LAMONGAN

1 ABI RIJAL RIFQI MALE 14/09/1995 LAMONGAN

2 ANTON PRIYO UTOMO MALE 4/01/1987 LAMONGAN
3 CANDRA APRILATU RIZAL MALE 01/04/1989 LAMONGAN
4 DAVID ALAMSYAH MALE 23/06/1996 LAMONGAN
5 RUSDIYANTO MALE 14/05/1987 LAMONGAN
6 HENGKI PURNOMO MALE 02/05/1989 LAMONGAN
7 KIKI MARTA DIANSYAH MALE 03/12/1990 LAMONGAN
8 KRISTIAN DWI PAMUNGKAS MALE 14/11/1990 LAMONGAN
9 MOH HARIYONO MALE 12/12/1989 LAMONGAN
10 SUNAWAN HADI SAPUTRA MALE 22/12/1987 LAMONGAN
11 VRENGKY HANTER MALE 28/05/1992 KUPANG
12 ULUL AZMI MALE 03/06/1997 LAMONGAN
13 MOHAMMAD MAHFUDHI MALE 05/12/1987 LAMONGAN
14 NOVIAN TSANI UTOMO MALE 08/08/1988 LAMONGAN
15 AFAN DWI HARTANTO MALE 30/05/1981 LAMONGAN
16 ABDUL MUAD MALE 09/02/1990 LAMONGAN
17 EKO BAGUS ZUHRI MALE 20/09/1989 LAMONGAN
18 TAUFIK HIDAYAT MALE 18/06/1985 LAMONGAN

1 SUGENG PRASETYO MEINARKO MALE 05/12/1989 LAMONGAN

2 FITRIANSYAH PERDANA PUTRA MALE 17/04/1991 GRESIK
3 DENNY FEBRIANTO NUGROHO MALE 17/02/1990 LAMONGAN
4 KACUNG SETIAWAN MALE 21/09/1988 LAMONGAN
5 RIADI MALE 04/10/1987 LAMONGAN
6 REDI LUSIANTO MALE 25/01/1998 LAMONGAN
7 WAHYUDI FITRIANTO MALE 28/07/1981 LAMONGAN
Mengetahui dan Menyetujui
Koordinator Regional
LAMONGAN

( M. Rifky Debrian )
 DAFTAR REGISTRASI MEMBER INTER CLUB INDONESIA
ICC 2016/2017

ALAMAT

Jl Lamongrejo Gg. Cendrawasih No. 19 Kec. Lamongan

Desa Duduk Lor RT 01 RW 05 Kec. Glagah

Desa Lopang RT 03 RW 02 Kec. Kembangbahu

Desa Kramat RT 02 RW 03 Kec. Lamongan

Desa Sumberbendo RT 01 RW 02 Kec. Mantup

Desa Kedungrejo RT 10 RW 03 Kec. Modo

Desa Brondong RT 02 RW 04 Kec. Brondong

Desa Deketwetan RT 02 RW 05 Kec. Deket

Jl Wahidin Sudirohusodo No. 102 RT 01 RW 04 Kel. Mendalan Kec. Lamongan

Jotosanur RT 01 RW 05 Kec. Tikung

Jl Sunan Bonang RT 09 RW 03 Kel. Solor Kec. Kota Lama

Centini RT 02 RW 07 Kelurahan Guyangan Kec. Laren

Jl. Pasar Lama 1 RT 06 RW 06 Kec. Paciran

Desa Banyubang RT 04 RW 01 Kec. Solokuro

Jl Karangrejo Sawahan Kel. Wonokromo

Kel. Pasir Gunung Selatan RT 06 RW 015 Kec. Cimanggis

Kel. Tiga Juru RT 03 RW 02 Ke. Mayong

Perum Graha Indah Blok U No. 20 RT 02 RW 11 Desa Tambakrigadung Kec. Tikung

Sukamatri 1 No. 14D/144D RT 04 RW 10 Kel. Sukaluyu Kec. Cibeunying

Kertajaya no. 41A Kelurahan Kertajaya

Desa Ploso Buden RT 03 RW 01 Kec. Deket

Desa Kruwul RT 06 RW 01 Kec. Turi

Desa Jubel Kidul RT 02 RW 01 Kec. Sugio

Desa Sukorejo RT 07 RW 02 Kec. Turi

Desa Geger RT 01 RW 03 Kec. Turi

Tugu Lor RT 01 RW 03 Desa Tugu Lor Kec. Kembangbahu

KODEPOS KOTA HP EMAIL

62214 LAMONGAN 62 81351731908 dennishabri@gmail.com

62992 LAMONGAN 62 85607135810 abirijalrifqij4@gmail.com

62282 LAMONGAN 62 8563497887

LAMONGAN 62 85645538639 candrarizal1908@gmail.com

62283 LAMONGAN 62 85710777791 dd121514@gmail.com
LAMONGAN 62 85645185888 roosdi.anto1908@gmail.com
LAMONGAN 62 85804314476 hengkycoba8888@gmail.com
62291 LAMONGAN 62 85869463769 diansyah031290@gmail.com
62212 LAMONGAN 62 85607407022 kristiandwip14@gmail.com
62281 LAMONGAN 62 8645504370 hariyono_moh@gmail.com
85000 KUPANG 62 81239864770 sun4w4n_hs@yahoo.com
LAMONGAN 62 81237308097 biscionerockrebel@gmail.com
62264 LAMONGAN 62 85732509714 azmypashter@gmail.com
62265 LAMONGAN 62 85649066110 el_mahfudh@yahoo.com
60243 SURABAYA 62 85732400508 badaxoyie@yahoo.com
DEPOK 62 82312044499 afanidw10@gmail.com
LAMONGAN 62 8975805331 inasnursyifa04@gmail.com
LAMONGAN 62 85646213666 bagusits2007@gmail.com
BANDUNG 62 85794201526

60286 SURABAYA 62 82234078354 sugengprastyo354@yahoo.com

LAMONGAN 62 85829696391 ferx_ugal@yahoo.com
62264 LAMONGAN 62 8225710344 deni10febrianto@gmail.com
LAMONGAN 62 85730522088 kacungs60@gmail.com
62252 LAMONGAN 62 86506567332 Facebook : andiegomilito

LAMONGAN 62 81556633321 rediredi251@gmail.com

62111 LAMONGAN 62 85707669999 yudie_dordia@yahoo.com
Mengetahui dan Menyetujui
Membership Regional
LAMONGAN

( KIKI MARTA DIANSYAH )

PAKET (COPPA, SCUDETTI,
M
CHAMPIONNI)

CHAMPIONNI M LUNAS Rp 650,000.00

SCUDETTI L LUNAS Rp 250,000.00

SCUDETTI L

SCUDETTI L LUNAS Rp 250,000.00

SCUDETTI L LUNAS Rp 250,000.00

SCUDETTI XL LUNAS Rp 250,000.00

SCUDETTI L LUNAS Rp 250,000.00

SCUDETTI L LUNAS Rp 250,000.00

SCUDETTI XL LUNAS Rp 250,000.00

SCUDETTI XL LUNAS Rp 250,000.00

SCUDETTI M

SCUDETTI L

SCUDETTI XL LUNAS Rp 250,000.00

SCUDETTI XXL LUNAS Rp 250,000.00

SCUDETTI XL LUNAS Rp 250,000.00

SCUDETTI L LUNAS Rp 250,000.00

SCUDETTI L LUNAS Rp 250,000.00

SCUDETTI L LUNAS Rp 250,000.00

SCUDETTI L LUNAS Rp 250,000.00

COPPA L LUNAS Rp 200,000.00

COPPA L LUNAS Rp 200,000.00

COPPA L LUNAS Rp 200,000.00

COPPA L LUNAS Rp 200,000.00

COPPA L LUNAS Rp 200,000.00

COPPA L

COPPA S LUNAS Rp 200,000.00

TOTAL Rp 5,600,000.00