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11/26結業外拍報名表 -- 台中清水眷村/永安漁港海螺屋 指導老師:陳春隆
欲報名參加 請填寫以下資料 (須投保旅平險)
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* Indicates required question
1.姓名
*
Your answer
2.性別
*
女
男
3.身分證字號
*
例 : H123456789 (含英文字母共10碼)
Your answer
4.出生日期 (民國年/月/日)
*
例: 56年3月21日
請輸入: 560321
Your answer
5.餐食
*
需訂素食
葷
6.上車地點
*
中壢土地公
桃園經國轉運站
7.意見提供
Your answer
感謝您的耐心填寫
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