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Formulir Pendaftaran Anggota BeATeRS Palu
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Isi dengan lengkap alamat Anda.
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isilah apabila anda memiliki Blackberry.
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Pekerjaan
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Pilih salah satu
Pelajar
Mahasiswa
Pegawai Negeri
Pegawai Swasta
Wiraswasta
Lainnya
Tipe Honda BeAT
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Pilih salah satu
Karburator
PGM-F1 (Injeksi)
Warna Honda BeAT
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Pilih salah satu
Merah
Biru Muda
Biru Tua
Hitam
Orange
Pink
Putih
Hijau/Putih
Biru/Putih
Lainnya (Custom)
Nomor Polisi
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Lampirkan STNK Motor BeAT anda dalam bentuk file *.jpg
Nomor SIM
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Lampirkan SIM anda dalam bentuk file *.jpg
Foto
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Dengan ini menyatakan bersedia menjadi anggota dan menaati aturan/tata tertib BeATeRS PALU.
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