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Marine Scout Member Form
Because we need the sea
Full name
Nickname
Date of birth
Address
E-mail
Mobile phone number
Gender :
*
Required
Boy / Male
Female / Male
Other
Your age :
*
Required
< 18 Years
19 - 30 Years
30 - 45 Years
45 - 60 Years
> 60 Years
Current job:
*
Required
student
Student
Civil Servant / BUMN
Private sector employee
Businessman
Other
Did you register as:
*
Required
Staff
Member
Volunteer Activities
Skills you can offer:
(Optional) Attach Brief Biodata + Photo
Max File Size 15MB
Submit
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