| 姓名 | 性别 | 身份证号 | 联系电话 | 科室 | |
| 报名1 | ____________ | ____________ | ____________ | ____________ | ____________ |
| 报名2 | ____________ | ____________ | ____________ | ____________ | ____________ |
| 报名3 | ____________ | ____________ | ____________ | ____________ | ____________ |
| 报名4 | ____________ | ____________ | ____________ | ____________ | ____________ |
| 报名5 | ____________ | ____________ | ____________ | ____________ | ____________ |