產學暨推廣處報名系統

會員資料填寫
Member Information Form


*身分證字號:
*Passport No. or ARC No.:
 

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

*密碼:
*Password:

*姓名:
*Name:


*性別:
*Gender:

*手機號碼:
*Cell phone No.:


*電子信箱:
*E-mail address:


郵遞區號:
Postal Code:


地址:
Address:


收據統一編號:
Business Unified Identification Number for Receipt:

收據抬頭:
Title for Receipt:

備註:
Note:


 
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個資宣告連結 Personal Information Declaration Link