English Club Membership Registration

Complete the form below to sign up for our membership service!

Name :

Email :

Phone Number :

Address :

Place and Birth Date :

Membership rules:
1. Membership is available to anyone who being promised to be willing to take the activity
seriously.
2. You promise NOT to be absent for 3 times in a row.
If that happens, I’m willing to be kicked out of the club.
3. Willing to pay cash of Rp.20.000 every month.

Parents/the guardian, me concerned,

Name and sign Name and sign

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