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申請者資料
因旅伴的數量有限,協會會視申請者的需求優先配給最需要的人。領取時以身障手冊領取。目前旅伴已發完,有需求者仍可填表申請,若有不適用返還的旅伴則會再發給後續的候補。如果需求數量夠多,協會會視需求生產新機器。
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姓名
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Your answer
出生日期
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MM
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DD
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YYYY
姓別
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女
男
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住家地址
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工作/學校地址
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Your answer
聯絡電話
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智慧型手機系統
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領有身障手冊
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是
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障別
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視障
聽障
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障礙等級
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需求包包類型
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側背
後背(適合學生使用)
是否願意將使用情況回饋給協會
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是
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