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109年青春專案宣導-兒少版
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姓名
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生理性別
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男
女
年齡
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12歲以下
13歲至15歲
16歲至18歲
身分證字號
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以利抽獎核對身分
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手機號碼
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範例：0912345678
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電子信箱
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您目前就讀
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國小
國中
高中(職)
大一新生
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