城中校區保健室B肝疫苗注射預約
注射時間:12:00~14:00,疫苗費用依總區保健中心公告
姓名
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系所/單位
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性別
學號
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身分證字號或居留證號(護照號碼)
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西元出生年/月/日(例:2000/01/01)
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手機號碼(例:0910-100-100)
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預約注射日期(地點)
注射劑別
其他特殊需求
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