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慈濟新北市三峽113學年度青少年成長班報名表
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1. 學員姓名
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Your answer
2. 請問是否是新學員?
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是
否
3. 出生年月日
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MM
/
DD
/
YYYY
4. 性別
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男
女
5. 就讀學校/年級
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Your answer
6. 連絡電話
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Your answer
7. 連絡人/關係
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