桃竹苗區
報名桃竹苗區(2017/08/12)六→新竹D1 Plaza (科學園區活力廣場)
參賽者姓名
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聯絡電話(市話)
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聯絡電話(手機)
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E-Mail
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通訊地址
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指導老師姓名
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指導老師電話
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指導老師手機
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指導老師地址
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參賽曲目(自選曲一首)
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是否需要輔助踏版
是否為音樂班
報名組別
樂器名稱 (管樂、國樂及其他組別,請註明樂器名稱)
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就讀年級 (一定要填寫,以便正確編號)
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繳費帳號及劃撥帳號
繳款方式
轉帳日期
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轉出帳號末五碼 (或劃撥序號8碼)
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備註
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