常州继教项目《新形势下基层儿童预防接种工作规范学习班》报名表

常州继教项目《新形势下基层儿童预防接种工作规范学习班》报名表1.参加培训单位[单选题]*○市人民医院○市中医医院○市妇幼保健院○市皮肤病防治所○市血站○戴埠镇中心卫生院○天目湖镇卫生院○天目湖镇平桥卫生院○上兴镇中心卫生院○上兴镇上沛卫生院○社渚镇中心卫生院○社渚镇周城卫生院○竹箦中心卫生院○别桥镇卫生院○上黄镇卫生院○溧城镇马垫卫生院○溧城镇中心卫生院○南渡镇中心卫生院○埭头镇卫生院○溧城镇清安卫生院○溧城镇新昌卫生院○溧城镇昆仑卫生院○其它2.人数[单选题]*○1○2○3○43.科教负责人姓名:[填空题]*_________________________________4.请输入您的手机号码：[填空题]*_________________________________5.您的姓名：[填空题]*_________________________________依赖于第2题第1;2;3;4个选项6.职称：[填空题]*_________________________________7.职务：[填空题]*_________________________________8.学历：[填空题]*_________________________________9.工作单位：[填空题]*_________________________________10.手机号码：[填空题]*_________________________________11.您的姓名：[填空题]*_________________________________12.职称：[填空题]*_________________________________13.职务：[填空题]*_________________________________14.学历：[填空题]*_________________________________15.工作单位：[填空题]*_________________________________16.手机号码：[填空题]*_________________________________17.您的姓名：[填空题]*_________________________________18.职称：[填空题]*_________________________________19.职务：[填空题]*_________________________________20.学历：[填空题]*_________________________________21.工作单位：[填空题]*_________________________________22.手机号码：[填空题]*_________________________________23.您的姓名：[填空题]*_________________________________24.职称：[填空题]*_________________________________25.职务：[填空题]*_________________________________26.学历：[填空题]*_________________________________27.工作单位：[填空题]*______