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Servas host_day host_traveler record_年度統計總表暨意見調查表
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* Indicates required question
中文姓名
*
Name
Your answer
您家的5碼郵遞區號為何?
*
Zip code (5-digit)
Your answer
您的會員身分（可複選）
*
Member type(s)
Host（住宿接待會員）
Day Host（旅遊接待會員）
Traveler（旅遊會員）
Required
您這次扮演的角色為何？（可複選）
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What kind of roles do you play this time?
Host（住宿接待）
Day Host（旅遊接待）
Traveler（旅遊）
Required
您這次Host/day host/ travel發生日期，例如1/1-1/10
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The date or period you host/ day host /travel this time, ex: 1/1-1/10 (Jan. 1-10)
Your answer
Host / 您這次共接待幾位國外訪客在家中入住? 請填數字
For host: How many travelers did you host in your place this time? Please fill in number.
Your answer
Host / 您這次共計接待國外會員住宿您家裡幾個晚上？請填數字
How many nights did you host this time? Please fill in number.
Your answer
Host / 您這次接待的國外會員來自哪個國家？
Host / Which countries are the travelers who you hosted from?
Your answer
Day Host / 您這次共接待day host多少國外會員？請填數字
How many travelers did you day host this time? Please fill in number.
Your answer
Day Host / 您這次接待day host的外國會員來自哪一個國家？
Which country/countries are the travelers you hosted from this time?
Your answer
Traveler / 您這次拜訪了幾個Servas 國家？請填數字
How many Servas countries did you visit in the trip? Please fill in number.
Your answer
Traveler / 您這次拜訪的host family遍布在哪些國家？
What are these Servas countries you visited in this trip?
Your answer
Traveler / 您這次共拜訪了幾個國外 Servas 家庭? 請填數字
How many hosts did you visit in this trip? Please fill in number.
Your answer
Traveler / 您這次共住在國外 Host 家中幾個晚上? 請填數字
How many nights did you stay with the hosts in this trip? Please fill in number.
Your answer
對於這次接待或接受接待的評語與建議
Your comments and suggestions for being hosted or hosting
Your answer
不論過去一年是否host/day host/travel，給Servas Taiwan的建議是：
*
Your comments and suggestions for Servas Taiwan
Your answer
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