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FORM PENDAFTARAN ANGGOTA PARTAI GELORA SAMARINDA
* Indicates required question
NAMA LENGKAP
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Your answer
No HP/ WA
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Your answer
TANGGAL LAHIR
*
Your answer
ALAMAT LENGKAP
KECAMATAN
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LOA JANAN ILIR
PALARAN
SAMARINDA ILIR
SAMARINDA ULU
SAMARINDA UTARA
SAMBUTAN
SUNGAI KUNJANG
SAMARINDA SEBERANG
SAMARINDA KOTA
SUNGAI PINANG
KELURAHAN
*
Your answer
NAMA JALAN /NO./RT/RW
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Your answer
PENDIDIKAN TERAKHIR
*
SD/MI
SMP/MTS
SMA/MAN
S1 PERGURUANG TINGGI
S2 PERGURUAN TINGGI
S3 PERGURUAN TINGGI
PEKERJAAN
*
Your answer
MOTIVASI GABUNG ANGGOTA PARTAI GELORA
*
BELAJAR POLITIK
JAGI ANGGOTA LEGISLATIF
CARI PENGALAMAN
Other:
Required
KONTRIBUSI YANG DISIAPKAN UNTUK PARTAI GELORA
*
JADI RELAWAN
DONATUR
Other:
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PROYEKSI KE DEPAN
*
JADI PENGURUS
JADI KADER
ANGGOTA SAJA
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