健檢報名時段

◎各方案內容：

◎請擇一時段，勿重複報名，若有問題請致信 "yyj1224@mail.ntust.edu.tw"。

Please select only one time slot and avoid duplicate registrations. If you have any questions, please contact " yyj1224@mail.ntust.edu.tw ".

*單位(Department):

*姓名(Name):

*性別(Sex):

*生日(Birthday):

*手機(Phone number):

*單位分機(Extension number):

*身分證字號/居留證號 ( ID / ARC number):

*身分別(Separate):

*電子郵件(E-mail):

健檢時段:

*健檢方案(Health check plan):

*是否已填寫完QR code問卷(Have you completed the QR code questionnaire?):

*驗證碼