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雙品VIP會員申請表
請放心,餅老闆不會隨意散佈您的個人資料
只會當做雙品文宣或優惠的聯絡方式
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* Indicates required question
姓名
*
Your answer
永久e-mail
*
Your answer
郵遞區號
Your answer
永久通訊地址
Your answer
生日
（請以西元,如1978年08月22日）
Your answer
手機
Your answer
個人臉書
Your answer
想對老闆說的話或建議
Your answer
備註(或何時領取)
Your answer
是否第一次填寫
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第一次填寫
以前填寫過,但因為資料更新,所以重新填寫
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