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入會申請表-台灣帕金森病友權益促進會
新會員入會費:新台幣1000元。
帕金森病友權益促進會之友,
感謝您的認同與支持。
匯款後請於,協會LINE群通知劉正玄會長。
聯絡人: # 劉正玄 0963-893693
匯款資訊如下:
銀行名稱:第一銀行-三重埔分行
銀行代號: 007
帳 號:211-10-150402
戶 名:社團法人台灣帕金森病友權益促進會
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Email
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1.姓名
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Your answer
2.身分別
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帕金森症病友
病友家屬
機構或團體
Other:
3.性別 (入會者為機構或團體,此項選填)
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男
我是機構或團體會員
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4.出生年份 (範例: 民國 58)
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5.通訊地址
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例如:新北市三重區中正北路518號8樓
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6.連絡電話-市話 (範例:02-29798452)
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7.連絡電話-手機 (範例:0987-259358)
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