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["安庆职业技术学院老年大学学员报名信息登记表"]
["姓名",null,"性别",null,"出生年月"]
["政治面貌",null,"联系电话",null,"微信号"]
["身份证号码",{"$nulls":3},"学历"]
["家庭地址"]
["原工作单位"]
["学员类别（请在对应\n类别的方框内打√）","新学员      囗",null,"老学员     囗"]
["学员类型\n（请在对应类型的\n方框内打√）","本校离退休教职工      囗",null,"校外离退休人员     囗 "]
[null,"本校离退休教职工家属     囗",null,"在职    囗"]
["与本校教职工关系\n（家属填写）","本校教职工姓名\n（家属填写）",null,"本校教职工\n工作部门\n（家属填写）"]
["申报课程（请在对应\n类别的方框内打√）","合唱      囗",null,"广场舞      囗"]
["您还希望开设哪些课程\n（请列举）"]
["紧急情况联络人姓名1",null,"紧急情况联络人电话1"]
["紧急情况联络人姓名2",null,"紧急情况联络人电话2"]
["紧急情况联络人姓名3",null,"紧急情况联络人电话3"]