2010 Intercollegiate English Speech Contest Application Form 2010 年全国大专院校英语演讲比赛报名表
CONTESTANT'S INFORMATION (参赛者资料)
In English :
Surname Given Name
In Chinese : 县 市 市乡 镇 路 街
□□□
段
巷
弄
号
楼
Tel : (____)___________________Mobile : ______________________ Fax : (____)_______________ E-mail : _____________________________________________________________________________
UNIVERSITY / COLLEGE
: (In English) _______________________________________________ : (In Chinese) _______________________________________________
(大 专 院 校)
Department : (科系) ___________________________________________________________________ Major Course : (主修) _____________________________ Year : (年级) _______________________
ACCOMPANYING COACH OR RELATIVE (Limited to one)
Name: (In English)_______________________________________ (In Chinese)__________________
Surname Given Name
Tel:_(____)__________________________________
Mobile : _______________________________
DECLARATION (声明) 我愿意遵守比赛规则及评审结果,并履行优胜者之权利及义务,我并确认我在本报名表之记载及我的 参赛资格都符合规定,若有虚伪,我同意主办单位撤销我的参赛资格,取回我所获之奖品,通知我的 学校做必要的处罚,我也同意赔偿主办单位及其他参赛者因此所遭受之损害与损失.
Signature RECOMMENDATION BY SCHOOL I recommend______________________for the above-mentioned English Speech Contest. Name Position Signature Department Date Date
REMARKS (附注) 1. All applications should be officially sealed and sent to : 台北扶轮社 (ROTARY CLUB OF TAIPEI) 台北市 10041 忠孝西路一段 38 号五楼 TEL: (02) 2381-0986 (Deadline) April 16, 2010 [报名至四月十六日止,以邮戳为凭] 2. Applicants are advised to apply as early as possible. 3. The Rotary Club of Taipei will notify all qualified applicants regarding details of the contest via E-mail or by registered mail before April 16, 2010.
Official School Seal 学校官印