2019永豐銀行阿里山雲端路跑延期退費申請表
本活動本周將重新申請路權,確認後將盡速公告舉辦日期。但活動延期而無法參加的跑友,請填寫此申請表。即日起到2019/5/31止開放申請,要退晶片跑友於此期間寄回晶片。

Refund Application for 2019 Sinopac Running on the top of cloud in Ali Mountain. Apply from now to May 31, 2019.
姓名 Name *
訂單編號 Order Number *
參加組別 Registration Item *
是否退晶片(若要退須寄回) Return Chip (If yes, please mail chip to us) *
物資寄送地址 Address *
聯絡電話 Telephone or cellphone number *
Email *
銀行帳戶 Bank Account (Bank/Branch/Account Name/Account)請註明銀行別/分行別/戶名/帳號 *
備註 Note
是否有加價購環保水杯或接駁車 Also buy cup or transfer service
Clear selection
是否有加價購旅遊平安險 Also buy insurance
Clear selection
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