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意潛海訓保險表單
請填寫正確，注意『西元』出生年月日。
緊急聯絡人姓名、稱謂都要填寫
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姓名
*
Your answer
西元出生年月日(注意不會是2023年!!!)
*
MM
/
DD
/
YYYY
身分證字號
*
Your answer
聯絡電話
*
Your answer
要去的海邊日期
*
如果你要去兩天海邊
MM
/
DD
/
YYYY
海訓日期2
*
MM
/
DD
/
YYYY
緊急聯絡人及稱謂(爸爸媽媽先生太太之類的)
*
Your answer
緊急聯絡人電話
*
Your answer
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