Name
7 B: A. M" i6 r. |) \# i8 w1 R | 1 x4 F4 m8 b( |" ]5 s9 U" N) O
: I5 \* r' r, f5 P5 x4 w
| Gender
( g, l$ q' N3 J) a4 Y | □Male □Female
# U- e- ^2 q2 y6 W6 k |
Passport No.
- q3 y1 B- v. w& Z# J7 T |
8 X9 Y8 K' Y6 s( h 8 H: |. o9 h8 k: S" x8 j
| Date of Birth
* i! F. J5 z1 g$ n3 ] | Year Month Day
/ e# L- M* q) ? |
Telephone 1 y' s8 o p- S' A$ H4 m
| (Mobile)
7 o& ]$ O0 K4 j' D) E1 t/ }4 d | (Home)
' q' z8 P7 Z6 h3 g) |! x" }: y | E-mail：; c5 e6 z! H8 s9 u, g, K
|
Fax $ k1 _+ _& }# ?) `
| # Z" [3 \' d- e% _
| Nationality
, v' Q8 D- c2 t8 X$ _8 Z, N% h0 w | |
Name of School
! c6 D6 `- B& W+ J% e+ M | 9 ?/ c ?7 P! I; ~6 C d
| Major / b4 q3 ~* b) e
| |
Address
0 O, L/ |5 o+ Z' j: \# s1 g3 A% k | - r, G7 K5 z8 C! t* o- W0 y# ]
|
Eating habits
/ K* M |* e1 x4 y( { | □Non-vegetarian
! S- f+ t5 b0 P, `: J□Vegetarian
1 V' N5 j. q, \4 R) X | Others： Requirements：" R/ e7 K8 M2 J A+ l2 e. |% Q, R
|
Attending Stage, O8 g# ^& E: ]
| □ First Stage 7/16（Mon.）~7/17（Tue.）(New Taipei City Hakka Museum )
" H" ]3 }( M, p3 P□ Second Stage 7/18（Wed）~7/19（Thu.）(New Taipei City Hakka Museum)
6 V+ l1 T7 c8 e, k% V/ [ |
Parents Information
' O: ~/ Z8 v2 h2 w4 D | Name of the parents
/ X0 g j2 c" _ | □Agree$ k; o% ]; m2 D" x" b
□Disagree5 n) S/ A7 r8 @
! s( B: u, w* ~ | Date of Birth$ y. {; e: m5 J' W% l
| Year Month Day; Y" c3 S. M! q, m7 f; s0 a
|
ID No.5 q7 u: M7 A9 V' v; P* E1 f5 x
| |
Parents Agreement
2 P; k' }# t+ ?6 s: ?4 V2 Q | Signature Date
" X" a# e. @8 s: s |
Emergency Contact person- L3 _* K4 s6 g% P
| (Mobile)
0 |3 s: q7 Z3 `1 B& ^) S: E | (Home)- N' Q0 a' U/ s6 C0 N
| (Work)
( o* h& X: o6 V, y7 H9 H3 X/ ` | Relationship to Applicant
& i! Q* K( \- B+ n |
Comments | Note:
# o1 }& m6 P* Q7 D3 D9 kPersonal Belongings: Sleeping bag or quilt , Toilet articles (Tooth cup, Toothbrush, Toothpaste, Towel), Clothing, Slippers, Coat, Umbrella, Healthy insurance card, Personal medications and a good mood.
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發表於 2012-5-21 09:03:55
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