基地營自然探索
活動課程線上報名表
報名行程與日期 *
Program
姓名 *
Name
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性別 *
Gender
國籍 *
Country
身分證字號或護照號碼 *
ID/Passport NO.
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出生年月日 *
MM
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DD
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YYYY
聯絡電話 *
Telphone or Mobile
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地址 *
Address in Taiwan
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電子郵件 *
E-mail
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緊急事故聯絡人 *
Emergency – Contact
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聯絡人電話 *
Emergency– Telephone
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