中醫婦科養生保健下午茶時光課程報名表
1. 請務必確實填寫每個欄位
    ***若是靖妃中醫診所患者,匯款金額請勾選優惠價欄位的選項
2. 講座地點: 靖妃中醫診所 (台北市敦化南路2段63巷58號)
3. 聯絡電話: 02- 27042328,27041568
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姓名: *
手機號碼: *
電子信箱: *
line ID: *
報名課程(可複選): *
Required
(非診所病患)匯款金額:
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(靖妃中醫診所病患優惠價)匯款金額:
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匯款者姓名及匯款帳號後5碼: *
*匯款方式
戶名:陳玫妃
陽信商業銀行:延吉分行
帳號:01601-007709-9
***請務必在報名表內填寫匯款帳號後五碼及匯款姓名,以便查詢繳費狀態。

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