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108年6月南湖大山賞花行
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姓名 Name
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請輸入您的姓名。Please enter your legal name.
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性別 Gender
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男 Male
女 Female
請問您的 E-mail?
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請輸入您的E-mail。Please enter your E-mail address.
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連絡電話 Phone
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請輸入您的手機或連絡電話。Please enter your phone number.
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身分證字號、護照號碼 Passport or Residence ID Number
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請輸入您的身分證字號、居留證或護照號碼。 Please enter your Passport Number or Residence ID Number.
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出生年月日 Date of Birth
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請輸入出生年月日。Please select your date of birth
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通訊地址 Communication Address
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請輸入通訊地址。Please enter your communication address if the residence address is not convenient to reach you.
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緊急連絡人名字 Emergency Contact Name
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請輸入緊急連絡人名稱。Please enter the name of emergency contatct.
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緊急連絡人電話 Emergency Contact Phone
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請輸入緊急連絡人電話。Please enter the phone number of emergency contatct.
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飲食習慣 Diet habit
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請問您是葷食或素食? Are you a vegetarian?
葷食 No, I'm not a vegetarian
素食 Yes, I am a vegetarian
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其他補充事宜 Other information
有無其他未竟事宜需要向我們告知?例如特殊疾病或過敏病史?Any other information you wish to tell us? Do you have any past medical history, like allergy or stroke?
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匯款帳號後五碼
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請將活動9,000元轉帳至花蓮二信(216),田蒲分社。戶名:阿爾卑斯學苑有限公司。帳號:070-00100013219
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