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海島瘋-國內潛水課程 報名表-台北 (Sing-Up Form & Medical Check)
填完報名表後會傳匯款帳戶給您,確認收到訂金後才算完成報名,謝謝。
報名課程(Diving Course) *
Required
中文姓名(First Name) *
Your answer
英文姓名(Last Name) *
請填入與護照相同之英文姓名
Your answer
綽號(Nick Name)
Your answer
出生年月日(Brithday Y/M/D) *
MM
/
DD
/
YYYY
性別(Gender) *
身高(Height) *
Your answer
體重(Weight) *
Your answer
鞋號(Size of Shoe) *
請填入「公分CM」或「US Size」
Your answer
電子郵件地址(E-mail Address) *
Your answer
住址(Recipient Address) *
請填可收到信的地址
Your answer
Line 帳號(Line ID) *
Your answer
手機號碼(Mobile) *
Your answer
預計上課日期(Date of Course) *
請先選擇一個預計上課的日期,確切時間教練會再跟您確認,謝謝。
MM
/
DD
/
YYYY
其他需求(Other Request)
若有任何相關問題,歡迎提出,謝謝。
Your answer
指導教練(可空白)
Your answer
從哪邊看到我們的課程資訊
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