JavaScript isn't enabled in your browser, so this file can't be opened. Enable and reload.
兒童急診專科醫師證書展延費用繳納線上登錄
親愛的醫師您好：
感謝您對於學會的支持，為便利專科醫師證書展延費繳納之確認作業，採行線上登錄作業，請您於繳費完成後，填寫以下簡單的資訊即可，感謝您的協助。
若有任何問題，歡迎隨時與本會秘書柯小姐聯繫。
聯絡電話：(04)2631-3058
Sign in to Google
to save your progress.
Learn more
* Indicates required question
您的中文姓名
*
Your answer
您的英文姓名
*
格式：Da-Da Chen
Your answer
證書費500元繳納日期
*
MM
/
DD
/
YYYY
證書費收據抬頭
*
個人
Other:
證書郵寄地址
*
Your answer
Next
Clear form
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google.
Report Abuse
-
Terms of Service
-
Privacy Policy
Forms
