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109年美國州際青少年交換計畫
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Email
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姓名
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英文姓名(請同護照大小寫)
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生日(西元年/月/日)
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LINE ID
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身分證字號
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手機
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電話(H)
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緊急聯絡人
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緊急聯絡人關係
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緊急連絡人電話
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永久地址
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通訊地址
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