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FORM DATABASE JEMAAT
Dalam rangka pembuatan Kartu Tanda Anggota GKI Sinode Wilayah Jawa Barat, mohon anda mengisi data di bawah ini dengan sebenar-benarnya.
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1
Asal Gereja
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GKI Agape
GKI Agus Salim
GKI Anugerah
GKI Ayudia
GKI Bandar Lampung
GKI Banjar
GKI Bekasi Timur
GKI Bogor Baru
GKI Buaran
GKI Bundasudi
GKI Bungur
GKI Camar
GKI Cawang
GKI Ciamis
GKI Cianjur
GKI Cibadak
GKI Cibeureum
GKI Cicurug
GKI Cikarang
GKI Cimahi
GKI Cipinang Elok
GKI Cipinang Indah
GKI Citra I
GKI Citra Raya
GKI Delima
GKI Delima
GKI Duta Mas Batam
GKI Filadelfia
GKI Gading Indah
GKI Gading Serpong
GKI Gatot Subroto
GKI Grand Wisata
GKI Griya Merpati Mas
GKI Guntur
GKI Gunung Sahari
GKI Halimun
GKI Harapan Indah
GKI Harapan Jaya
GKI Indramayu
GKI Jambi
GKI Jatibarang
GKI Jatinegara
GKI Kalideres
GKI Kanaan
GKI Karbela
GKI Kavling Polri
GKI Kavling Polri
GKI Kayu Putih
GKI Kebonjati
GKI Kedoya
GKI Kemang Pratama Bekasi
GKI Kepa Duri
GKI Kosambi Baru
GKI Kosambi Timur
GKI Kota Modern
GKI Kota Wisata
GKI Kranggan
GKI Kuningan
GKI Layur
GKI Mangga Besar
GKI Maulana Yusuf
GKI Melur
GKI Metro Lampung
GKI Muara Karang
GKI Nurdin
GKI Pakis Raya
GKI Pakuwon
GKI Pamanukan
GKI Pamitran
GKI Pasirkaliki
GKI Pasirkoja
GKI Pekanbaru
GKI Pengadilan Bogor
GKI Pengampon
GKI Penginjil
GKI Perniagaan
GKI Perumnas I
GKI Pinangsia Gloria
GKI Pondok Makmur
GKI Puri Indah
GKI Rahmani
GKI Raya Hankam
GKI RE Martadinata
GKI Rengasdengklok
GKI Samanhudi
GKI Samanhudi
GKI Serang
GKI Seroja
GKI Sindanglaut
GKI Sindanglaut
GKI Sion
GKI Sudirman
GKI Sumbawa Dua
GKI Sunda Kelapa
GKI Sunter
GKI Surya Utama
GKI Surya Utama
GKI Sutopo
GKI Taman Aries
GKI Tanggamus Gisting
GKI Terang Hidup
GKI Terate
GKI Tubagus Angke
GKI Veteran
GKI Villa Melati Mas
GKI Wahid Hasyim
GKI Zaenal Zahse
Please Select
Please Select
GKI Agape
GKI Agus Salim
GKI Anugerah
GKI Ayudia
GKI Bandar Lampung
GKI Banjar
GKI Bekasi Timur
GKI Bogor Baru
GKI Buaran
GKI Bundasudi
GKI Bungur
GKI Camar
GKI Cawang
GKI Ciamis
GKI Cianjur
GKI Cibadak
GKI Cibeureum
GKI Cicurug
GKI Cikarang
GKI Cimahi
GKI Cipinang Elok
GKI Cipinang Indah
GKI Citra I
GKI Citra Raya
GKI Delima
GKI Delima
GKI Duta Mas Batam
GKI Filadelfia
GKI Gading Indah
GKI Gading Serpong
GKI Gatot Subroto
GKI Grand Wisata
GKI Griya Merpati Mas
GKI Guntur
GKI Gunung Sahari
GKI Halimun
GKI Harapan Indah
GKI Harapan Jaya
GKI Indramayu
GKI Jambi
GKI Jatibarang
GKI Jatinegara
GKI Kalideres
GKI Kanaan
GKI Karbela
GKI Kavling Polri
GKI Kavling Polri
GKI Kayu Putih
GKI Kebonjati
GKI Kedoya
GKI Kemang Pratama Bekasi
GKI Kepa Duri
GKI Kosambi Baru
GKI Kosambi Timur
GKI Kota Modern
GKI Kota Wisata
GKI Kranggan
GKI Kuningan
GKI Layur
GKI Mangga Besar
GKI Maulana Yusuf
GKI Melur
GKI Metro Lampung
GKI Muara Karang
GKI Nurdin
GKI Pakis Raya
GKI Pakuwon
GKI Pamanukan
GKI Pamitran
GKI Pasirkaliki
GKI Pasirkoja
GKI Pekanbaru
GKI Pengadilan Bogor
GKI Pengampon
GKI Penginjil
GKI Perniagaan
GKI Perumnas I
GKI Pinangsia Gloria
GKI Pondok Makmur
GKI Puri Indah
GKI Rahmani
GKI Raya Hankam
GKI RE Martadinata
GKI Rengasdengklok
GKI Samanhudi
GKI Samanhudi
GKI Serang
GKI Seroja
GKI Sindanglaut
GKI Sindanglaut
GKI Sion
GKI Sudirman
GKI Sumbawa Dua
GKI Sunda Kelapa
GKI Sunter
GKI Surya Utama
GKI Surya Utama
GKI Sutopo
GKI Taman Aries
GKI Tanggamus Gisting
GKI Terang Hidup
GKI Terate
GKI Tubagus Angke
GKI Veteran
GKI Villa Melati Mas
GKI Wahid Hasyim
GKI Zaenal Zahse
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2
No. Anggota
*
This field is required.
No anggota di jemaat
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3
NIK KTP
Opsional
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4
Nama Lengkap
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This field is required.
Sesuai KTP
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5
Alamat Domisili
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This field is required.
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6
Kota
*
This field is required.
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7
No. Handphone / Whatsapp
*
This field is required.
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8
No. Telepon
Opsional
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9
Alamat Email
*
This field is required.
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10
Jenis Kelamin
*
This field is required.
Pria
Wanita
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11
Golongan Darah
*
This field is required.
A+
B+
AB+
A-
B-
AB-
O+
O-
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12
Pendidikan Terakhir
*
This field is required.
SD
SMP
SMA/SMK/SLTA/STM
D1
D3
S1
S2
S3
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13
Pekerjaan
*
This field is required.
Karyawan Swasta
Pegawai Negeri
Pelajar/Mahasiswa
Wiraswasta
Ibu Rumah Tangga
Profesional
Petani
Lain-lain
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14
Kelompok Etnis
*
This field is required.
Please Select
Tionghoa
Jawa
Batak
Minahasa
Ambon
Papua
Sunda
Nias
Timor
Dayak
Toraja
Lain-lain
Please Select
Please Select
Tionghoa
Jawa
Batak
Minahasa
Ambon
Papua
Sunda
Nias
Timor
Dayak
Toraja
Lain-lain
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15
Golongan
*
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Pendeta Emeritus
Pendeta
Penatua
Anggota Sidi
Anggota Baptisan
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16
Tanggal Lahir
*
This field is required.
-
Date
Year
Month
Day
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17
Tanggal Baptis
-
Date
Year
Month
Day
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18
Tanggal Sidi
-
Date
Year
Month
Day
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19
Tanggal Masuk Anggota
-
Date
Year
Month
Day
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20
Pas Foto (3x4)
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