精卵捐贈線上報名
謝謝您的愛心, 也將是一對夫妻的新希望 !!
姓名:
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性別:
出生年月日:
(例:民國75年1月5日填寫:750105)
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現居地址縣市
戶籍地址
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身分證字號:
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統一編號:
(本國籍不必填,外籍人士必填)
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護照號碼:
(本國籍不必填,外籍人士必填)
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國籍:
外籍人士請在其他欄位填寫國籍
身高:
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體重:
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血型:
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膚色:
就學狀況:
就業狀況:
抽菸:
喝酒:
個性:
初次捐贈:
E-mail:
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聯絡電話:
(例:0225237680)
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方便聯絡時間:
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