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2017 6B, 7A & 10B
FORM R21C
3501
: 1. 2. 3. () Call (Badge) Name () Family Name () Given Name
(2017-18) RC ARC RPIC ARPIC RRFC ARRFC EMGA EPNC
DG(17-18) PDG(16-17 and earlier) DGE(18-19) DGN(19-20) AG (17-18) Club-P PP Rotarian
: : :
: 1. ___________________ 2. 3.
:
E-mail : _____________________________________________________________________________________________
: +________________________ : + ______(______)______________ : +_______________________
(GETS) () NT$ 11,000 NT$ (GNTS) () NT$ 5,100 NT$ (DTTS) NT$ 3,150 NT$ (RRFS) () NT$ 2,800 NT$ () NT$ 3,800 NT$ () NT$ 6,300 NT$ () NT$ 4,100 NT$ (+) NT$ 10,000 NT$ NT$ : 1. 2017 10 31 1000
2. 2017 10 31 .
1. 2. Visa 3. MasterCard
Exp : Security Code :
_______________________________; ()______________________________
: +886-37-481768 Email : [email protected] PP Peter Wu : +886 932 613 766 2017taipeirotaryinstitute.org
(GETS) November 29-30, 2017 9:00-17:00 (GNTS) November 30, 2017 9:00-17:00 (DTTS) November 30, 2017 9:00-17:00 (RRFS) December 1, 2017 9:00-14:00 November 30, 2017 7:00-13:00 December 1-3, 2017
2017 12 1 - 3
.
Call (Badge) Family Name First Name
fill_1: 2: 3: fill_4: fill_5: 1: 2_2: 3_2: fill_9: Email: fill_13: undefined: undefined_2: fill_11: fill_12: fill_19: fill_20: fill_21: fill_22: fill_23: fill_24: fill_25: fill_26: fill_27: fill_28: fill_29: fill_30: fill_31: fill_32: fill_33: fill_34: fill_35: fill_18: Text1: Text2: Group3: Group4: Text5: Text6: Text7: Text8: Text9: Text10: Text11: Text12: Text13: Text14: Text15: Text16: Text17: Text18: Text19: Text20: Text21: Text22: Text23: Text24: Text25: Text26: Text27: