Name
2 N+ M/ p- C+ S! P0 d | 6 K- P6 p3 B5 I9 f2 O# C6 S
) a2 J8 G' w) _& v
| Gender+ B* K' j* T% O) U7 j. W3 n' W
| □Male □Female
]' W$ ^' e* Z) d7 _ |
Passport No.6 b7 A5 s6 H+ |, j; `; D
| 9 W; T) X+ p! W7 ~& { Y
9 U2 m" d1 h9 ]
| Date of Birth
1 n0 [/ }+ m3 \$ G | Year Month Day: U: h/ l$ g$ `" r' c% P! w
|
Telephone $ b; b- A' S! j( `. V, D* L) {) I! u, O
| (Mobile)
$ p$ C) ]. u3 a- ~" R, L* Q | (Home)9 ?( O s0 m& R7 q, E" K
| E-mail：. I# S# Z4 q8 q X$ r. {
|
Fax $ T. L9 k9 b! J% o- M2 v+ j& X
| ! g9 n X4 e, R/ O
| Nationality
6 ~* V# x( H; ~' `9 p6 r$ K4 j | |
Name of School% a3 [( b: @' Z: |3 E
|
9 d: @! m8 V1 H1 j | Major
" h: ?8 e! ]9 B9 g: j | |
Address
, H* j* ~9 Z7 c3 G- z# g( z# x: ^1 O# E6 L | + G6 }" q* a( o4 S- e' v* n2 u" h
|
Eating habits2 p7 I* r& D8 |& R J9 z
| □Non-vegetarian " Y+ t- T0 N) s& w' O" ^7 V) B
□Vegetarian
& L3 W: b" l% }# a | Others： Requirements：
, ?* n+ w/ L# s; r! i |
Attending Stage$ v5 S4 \! R- ]& ?
| □ First Stage 7/16（Mon.）~7/17（Tue.）(New Taipei City Hakka Museum )
' F& T4 t' Y9 d$ u/ p+ [. O$ z3 u□ Second Stage 7/18（Wed）~7/19（Thu.）(New Taipei City Hakka Museum)
6 k( D a+ x8 n4 [3 y+ L |
Parents Information
! i' n0 J' q+ s: g | Name of the parents
& _4 _3 H! v# n1 m( E5 s | □Agree; L* D# l' m: h- P5 }8 L
□Disagree( y* A( E% d" G! }: \8 f
1 Q! L# N7 ~) h. V+ z | Date of Birth5 z; t$ Y9 a: S( T4 u
| Year Month Day, u, u; f1 }* g( B2 F; g9 V- o9 v: \
|
ID No.7 R: [2 }) |1 U/ V
| |
Parents Agreement
0 c/ H f/ }5 v$ D! X# W | Signature Date
0 r8 G1 V7 K3 b2 S5 \ |
Emergency Contact person
: i& @/ M: u4 R% J! G | (Mobile)+ g+ u& R: `/ T- p+ I
| (Home)8 b7 E" |2 _) W+ y/ y- h* o
| (Work)
% x+ X$ [% f* S/ \ | Relationship to Applicant
- E% |/ K1 Y9 R- s; c g; o |
Comments | Note: ( U4 Q' y' [/ F" X& s* N' Z
Personal 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. & { o) D" ~" F, {
|
發表於 2012-5-21 09:03:55
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