Online Registration
1. Account Registration
2. Vaccine Booking
Warning!
Please fill this form with your identity correctly.
First Name
*
Last Name
*
Email (Username)
*
Password
*
At least 6 characters and no more than 32 characters
Identity Card Number (NIK)
*
Date of Birth
*
Gender
*
Male
Female
Phone Number
*
Home Address
*
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