西湖資優班gs21畢旅報名資料

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西湖資優班gs21畢旅報名資料

請要參加此次花蓮畢旅的同學填妥報名資料，同行的家長也要填寫，才能處理後續的保險、訂票、訂房問題。

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姓名 *

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生日 *

格式：民國年/月/日(例如87/09/20)

Your answer

身分證字號 *

Your answer

手機號碼 *

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緊急連絡人姓名 *

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緊急連絡人電話 *

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email *

請填常用的email，老師可以順便更新通訊錄

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