UNIVERSITY OF AMIR HAMZAH MEDAN
Special Lecture Program (Hybrid / Blended) - UHAMZAH MEDAN
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Campus UHAMZAH : Jl. Pancing Pasar V Barat Medan Estate. Kab. Deli Serdang
Catalog/Brochure Request Form
FREE via Mail (Post)
If you need a catalog / brochure for your partner (with the same address),
it can be done by
writing a few names
,
for example : Arif Raharjo, Budi Ahmadi, Cecep Setiawan, and so on.
We will send you a catalog / brochure in accordance with the number of names written.
If you want the catalog / brochure is also sent to several friends / family
with a different address
, then please also fill in Name & Address other (names, addresses, and so on).
Recipient's name
required
Address
(Address, Houses No., RT/RW, etc.)
required
City/Province
required
Zip Code
required
Email
can be emptied
Each time you fill the "name" below, then the address, city, and its POS codes are required.
Name 2
can be emptied
Address 2
can be emptied
City/Province 2
can be emptied
Zip Code 2
can be emptied
Name 3
can be emptied
Address 3
can be emptied
City/Province 3
can be emptied
Zip Code 3
can be emptied
Name 4
can be emptied
Address 4
can be emptied
______________
City/Province 4
can be emptied
Zip Code 4
can be emptied
Request catalog / brochure can also be done by
send your name and address
via SMS to mobile :
0817 0816 486
