Form #YukBerhentiMerokok

FORM #YukBerhentiMerokok

  1. Nama              : __________________________________________________________
  2. TTL                 : __________________________________________________________
  3. Alamat            : __________________________________________________________
  4. No Telp/HP  : __________________________________________________________
  5. Alasan Berhenti Merokok  : (panduan di sini)
  6. Ceritakan Pengalaman anda berkenalan dengan rokok hingga ingin berhenti: (dalam bentuk paragraf)
  7. Berapa batang/bungkus konsumsi Rokok anda setiap minggunya?  __________________

Isi form, mention us, dan form dikirim ke Corpora@ymail.com

Ini saatnya berhenti merokok! #YukBerhentiMerokok

Salam,
Marketing Team Corpora Training and Therapy
Follow Us on Twitter: @Corpora_

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