第二十一屆大藥盃PCE個人報名表(中文組)

※此表為本屆5/18~19 大藥盃PCE中文組,5/18複賽 開放網路個人報名表.
初級,進階級皆可填寫使用!

初級定義: 大一至大二,藥學生.
進階級定義: 大三(含)至更高年級,大學部藥學生.
符合進階級報名資格者,不可報名初級,違反者視同棄權.

※報名費500元/人(含保險,參賽證明獎狀);於5/18複賽檢錄時現場繳交.
詳細時間與地點,將於報名後,統一由主辦單位寄發通知函說明.

如果對於報名表的填寫有任何問題,請洽詢各校領隊,或是上網站與大藥盃大會人員聯絡。
聯絡人-嘉藥 姚登瀚 0910402639

    一、個人資料項目

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    二、個人健康部份

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    三、團體保險部份 (請務必填寫正確)

    若您同時參加大藥盃其他競賽項目,並且已納入保險者,也請填寫PCE保險資料.並請於報名表第四項,"大藥盃PCE競賽部分",填寫您的大藥盃其他參賽項目,提醒主辦單位. 倘有上述情形,經主辦單位查證後,將免於二次保險.
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    四、大藥盃PCE競賽部份

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    五、便當

    一個60元(報名費不含),若不訂可不用填,以每隊為單位發放,若同時參加多項比賽,請選擇其中一支隊伍,以利統計。 (統一在PCE選手休息室發放!!)
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