Green Power Indonesia
Jalan Cisaranten Kulon-Soekarno Hatta Bandung
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------------ FORMULIR PENDAFTARAN ------------
Nama Lengkap : ..................................................................................
Tempat tanggal Lahir : ...........................................................................
Alamat Lengkap : ...........................................................................
Alamat Email/FB : ...........................................................................
No Hp/TLP Rumah : ...........................................................................
Pekerjaan : ...........................................................................................
Alamat Tempat Kerja : ..........................................................................
Nama Bank, Cabang : ...........................................................................
No Rekening : ......................................................................................
Atas Nama : ..........................................................................................
(Harap Kirim Via email ke alamat email : greenpowerindonesia@gmail.com)
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