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+62-31-7390888
Pakuwon Golf & Family Club
(Managed by Sheraton Hotels & Resorts)
Vila Bukit Regensi Pakuwon Indah - Surabaya 60123 - Indonesia
Phone: (62)(31) 7390888 ·
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GOLF MEMBERSHIP APPLICATION FORM
Please select the package*:
Individual Single 1 Year Platinum
Individual Single 1 Year Gold
Individual Couple 1 Year Platinum
Individual Couple 1 Year Gold
Corporate 1 Year Platinum
Corporate 1 Year Gold
Individual Applicant / Corporate Nominee
Member Information
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Mr
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Ms
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Other
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:
KTP/SIM/Passport*
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E-mail*
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Address*
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Mobile / HP
:
Status*
:
Single
Unmarried
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Birthday of Couple
:
January
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2003
2004
2005
2006
2007
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2009
2010
Date Of Birth*
:
January
February
March
April
May
June
July
August
September
October
November
December
1
2
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31
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1950
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1960
1961
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1963
1964
1965
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1969
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1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Nationality*
:
Spouse Information
Select
:
Mr
Mrs
Ms
Miss
Other
Fullname
:
KTP/SIM/Passport
:
E-mail
:
Mobile / HP
:
Date Of Birth
:
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
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25
26
27
28
29
30
31
,
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
Nationality
:
Children information (Under 15 Year Old)
1.
Fullname
:
Date Of Birth
:
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
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20
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25
26
27
28
29
30
31
,
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Sex
:
Male
Female
2.
Fullname
:
Date Of Birth
:
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
,
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Sex
:
Male
Female
3.
Fullname
:
Date Of Birth
:
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
,
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Sex
:
Male
Female
4.
Fullname
:
Date Of Birth
:
January
February
March
April
May
June
July
August
September
October
November
December
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
,
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
1991
1992
1993
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
2007
2008
2009
2010
Sex
:
Male
Female