敬邀參加「Hold不住的尿意，認識膀胱與下泌尿道症狀」講座。

(Off-Campus)

* Required

* Name：
* Gender：
*Affiliation/Department： /
* Job Title：
* Contact Number.：    Mobile：
Please provide at least one of the following: home telephone, office extension, or mobile phone
Fax：
*Email：
Note：
Authentication code： Please enter the exact characters shown in picture below
I have read and agree that the registration system may collect relevant personal information:
  1. In accordance with Article 6 of the Personal Information Protection Act, the registration system provides a Privacy Statement prior to collection of personal information.
  2. Refusal of the Privacy Statement will result in unsuccessful registrations.