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* Indicates required question
Email
*
Your email
Registration date (bulan, hari, tahun)
*
MM
/
DD
/
YYYY
Child's Name:
*
Your answer
Father's Name (for child)
*
Your answer
Mother's Name (for child)
*
Your answer
Gender
*
Female
Male
Date of Birth (tanggal lahir - bulan, hari, tahun)
*
MM
/
DD
/
YYYY
Home Address
*
Your answer
City
*
Your answer
Phone Number (Home)
*
Your answer
Phone Number (Mobile)
*
Your answer
Whatsapp number
*
Your answer
Instagram Account (if none, enter none)
*
Your answer
Facebook Account (if none, enter none)
*
Your answer
School's Name
*
Your answer
Grade
*
Your answer
English Education Goal
*
Your answer
Check all your times available for an EfeX class:
Senin/Rabu
Senin/Kamis
Selasa/Kamis
Selasa/Jumat
1:00-2:00pm
2:00-3:00pm
3:00-4:30pm
4:30-5:45pm
5:45-7:00pm
Senin/Rabu
Senin/Kamis
Selasa/Kamis
Selasa/Jumat
1:00-2:00pm
2:00-3:00pm
3:00-4:30pm
4:30-5:45pm
5:45-7:00pm
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