學員資料填寫
Student Information Form

*身分證字號:
*Passport No. or ARC No.:
*密碼:
*Password:
*姓名:
*Name:


*出生年月日:
*Birth Date:
西元 Year年 Year月 Month日 Date

*性別:
*Gender:
*手機號碼:
*Cell phone No.:


*緊急聯絡人:
*Contact Person for Emergency:
姓名 Name:
電話 Telephone No.:
與緊急連絡人關係 Relationship of Contact Person for Emergency:

*電子信箱:
*E-mail address:


*就讀學校:
*Current Study Institution:

成人教育,學校請填校名或9,年級請填9。
For adult education, please key in the name of your school or the number 9.
*年級:
*Grade:

For adult education, please key in 9 for the grade.
收據統一編號:
Business Unified Identification Number for Receipt:
收據抬頭:
Title for Receipt:
備註:
Note:


I agree to the service regulations, privacy settings and registration notice of Industry-academia Collaboration and University Extension Division   
個資宣告連結 Personal Information Declaration Link