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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 · Contact Us · Announcements ·    · Map

HEALTH CLUB MEMBERSHIP APPLICATION FORM

Please select the package*:

Expatriate (Monthly Basis) : Single   Couple   Family  
6 (Six) Months Membership : Single   Couple   Family  
1 (One) Year Membership : Single   Couple   Family  
Corporate (Yearly Basis) minimum 3 persons
Student Package (Yearly Basis) - under 18 years old

Individual Applicant / Corporate Nominee

Member Information

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Fullname*:
KTP/SIM/Passport*:
E-mail*:
Address*:
Telephone*:
Mobile / HP:
Status*:
Date Of Birth*: ,
Nationality*:

Spouse Information

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Fullname:
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Children information (Under 15 Year Old)

1.Fullname:
Date Of Birth: ,
Sex:  Male   Female
2.Fullname:
Date Of Birth: ,
Sex:  Male   Female
3.Fullname:
Date Of Birth: ,
Sex:  Male   Female
4.Fullname:
Date Of Birth: ,
Sex:  Male   Female