BeClass 線上報名系統

106學年度第一學期文化之旅 Culture Trip (2017-12-02)(報名截止)

※ 姓名/Full Name:
※ EMAIL:
※ 電話/Cellphone Number:
中文姓名 / Your Name in Chinese:
性別/Gender:


生日/Date of Birth:
一月January; 二月 February; 三月March; 四月April; 五月May; 六月 June; 七月July; 八月August; 九月 September;十月October;十一月November; 十二月December
身份證號碼/護照號碼(保險用)Passport Number (for insurance):
保險受益人/關係Insurance Beneficiary / Relationship (for:
飲食習慣Dietary information:
過敏食物Allergenic Foods:
同行朋友 / Who joins the trip with you?:
It′s for arranging the hotel room.
注意事項/Notice:
我保證以上所填内容真實。、如有不實之處,本人願承擔一切法律責任。 I hereby declare that the information given above is true, correct and complete, for which I shall bear all the legal responsibilities


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