Basic data

Username

Password

Confirm password

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Surname

First name

Tanggal Lahir

Alamat

(still 255 characters)

Kabupaten/ Kota

Provinsi

Telepon/ WhatsApp

Jenis Kelamin

Male Female

E-mail

Farm Data

Nama Farm

No. Register (P3SI)

Nama Ring

No. Register Ring (P3SI)

Pengda

Pengwil

Jumlah Kandang

Confirm value

Authentication code

Send