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["高雄市土木技師公會會員入會申請資料表",{"$nulls":5},"請浮貼照片"]
["編        號",null,"姓           名"]
["性        別",null,"出生年月日"]
[" 身    份    證    字    號"]
["通訊住址"]
["戶籍住址","               縣市              市鄉區鎮               村里         鄰             路       段       巷       弄         號 "]
["連絡電話","H：(        )                              O：(       )                                 行動電話："]
["傳真電話","H：(        )                              O：(       )                                "]
["電子信箱","以電子郵件收公會訊息：□同意□不同意"]
["執業機構",null,null,"等級","甲〈 〉乙〈  〉丙〈 〉；受聘〈  〉自營〈 〉"]
["最高學歷","(學校名稱)",null,"科  系   所"]
["經        歷","服務單位(含公職經歷)",null,"年         資",null,"職     務    名     稱","職   務   名   稱"]
[1,null,null,"    年"]
[2,null,null,"    年"]
[3,null,null,"    年"]
["匯 款 銀 行 全 名",null,"分    行    別",null,"帳                             號"]
[]
["參       加       其       他       公       會"]
["執       業       機       構       地       址"]
["執       業       機       構        電       話"]
[" 本人願意遵守高雄市土木技師公會組織章程及政府相關法令之規定申請加入為會"]
[" 員，茲填本人資料如上並檢附：(1)申請人相片五張。(2)身份證影本正反面一份。"]
[" (3)技師證書影本正反面一份。(4)a、技師執業執照影本正反面一份或 b、受聘公司"]
[" 開立之受聘同意書及營造業登記證影本正反面一份。(5)蒐集、處理及利用個人"]
["資料告知暨同意書，供本會留存。(6)切結書                                              "]
["                                          技師簽章：              印"]
["                                                                               入會日期：       年       月       日"]
["註：(1)入會費：1,000元  (2)常年會費：2,000元  (3)福利基金：10,000元  (4)捐助費：42,000元，共計：55,000元"]

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