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Pengisian Data Peserta Onsite A
Please fill the empty space below according to your ID Card (Passport if you are foreigner)
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* Indicates required question
Nama Lengkap (Full Name)
*
Your answer
Nama Panggilan (Preferred Name)
*
We provide an ID Card for each of you to enter the conference. So preferred name will be needed
Your answer
Jenis Kelamin (Gender)
*
Laki - laki (male)
Perempuan (female)
Usia (Age)
*
Your answer
Kota Domisili (City)
*
Kota Dimana Anda tinggal saat ini
Your answer
Asal Provinsi (Origin)
*
Dari provinsi mana Anda berasal
Your answer
Asal Kota (City)
*
Dari Kota mana Anda berasal
Your answer
Nomor Telepon / HP (Phone Number)
*
Your answer
Gereja / ministry / institusi / pribadi (Church/ministry/organisation/personal)
*
Which community do you come from or represent
Your answer
Status
*
Pelajar (School)
Mahasiswa (University)
Bekerja (Marketplace)
Sesi yang Anda Ikuti (Session that you'll join)
*
Session 1
Session 2
Session 3
Session 4
Session 5
Session 6
Session 7
Required
Pertanyaan Lain -lain (Other Questions)
Your answer
Apakah Bapak/Ibu/Sdr Mempunyai Penyakit Pribadi?
*
Tidak
Ya
Other:
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