常州繼教項目《新形勢下基層兒童預防接種工作規范學習班》報名表1.參加培訓單位[單選題]*○市人民醫院○市中醫醫院○市婦幼保健院○市皮膚病防治所○市血站○戴埠鎮中心衛生院○天目湖鎮衛生院○天目湖鎮平橋衛生院○上興鎮中心衛生院○上興鎮上沛衛生院○社渚鎮中心衛生院○社渚鎮周城衛生院○竹簀中心衛生院○別橋鎮衛生院○上黃鎮衛生院○溧城鎮馬墊衛生院○溧城鎮中心衛生院○南渡鎮中心衛生院○埭頭鎮衛生院○溧城鎮清安衛生院○溧城鎮新昌衛生院○溧城鎮昆侖衛生院○其它2.人數[單選題]*○1○2○3○43.科教負責人姓名:[填空題]*_________________________________4.請輸入您的手機號碼：[填空題]*_________________________________5.您的姓名：[填空題]*_________________________________依賴于第2題第1;2;3;4個選項6.職稱：[填空題]*_________________________________7.職務：[填空題]*_________________________________8.學歷：[填空題]*_________________________________9.工作單位：[填空題]*_________________________________10.手機號碼：[填空題]*_________________________________11.您的姓名：[填空題]*_________________________________12.職稱：[填空題]*_________________________________13.職務：[填空題]*_________________________________14.學歷：[填空題]*_________________________________15.工作單位：[填空題]*_________________________________16.手機號碼：[填空題]*_________________________________17.您的姓名：[填空題]*_________________________________18.職稱：[填空題]*_________________________________19.職務：[填空題]*_________________________________20.學歷：[填空題]*_________________________________21.工作單位：[填空題]*_________________________________22.手機號碼：[填空題]*_________________________________23.您的姓名：[填空題]*_________________________________24.職稱：[填空題]*_________________________________25.職務：[填空題]*_________________________________26.學歷：[填空題]*_________________________________27.工作單位：[填空題]*______