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中山女高~110年交大電機一日體驗營 報名表
線上表單填寫後，請務必將紙本報名表&家長同意書於12/11(五)12:30前繳交至教務處實研組。
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* Indicates required question
班級
*
如:二仁
Your answer
姓名
*
如:吳小卿
Your answer
座號
*
如:1
Your answer
學號
*
Your answer
生日
*
MM
/
DD
/
YYYY
身分證字號
*
活動保險使用
Your answer
學生手機號碼
*
如:0921225225
Your answer
學生e-mail
*
Your answer
當天用餐
*
葷
素
緊急聯絡人姓名
*
Your answer
緊急連絡人之關係
*
如:父女、母女
Your answer
緊急連絡人手機
*
如:0921223223
Your answer
填寫完畢，提醒同學，請務必將紙本報名表&家長同意書於12/11(五)12:30前繳交至教務處實研組，未繳交者視同未完成報名。
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