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溪州鄉公所-112年度新住民識字班
上課人數20人，報名額滿截止。
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一、姓名
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男
女
二、上課班別：
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新住民識字班
國籍：
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Your answer
三、出生日期(西元)：
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MM
/
DD
/
YYYY
四、年齡：(幾歲)
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Your answer
五、身分證號或居留証字號：
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Your answer
六、住址：
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Your answer
七：電話或手機
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Your answer
八、緊急聯絡人姓名、關係
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Your answer
九、緊急聯絡人電話
Your answer
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