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<DIV><FONT size=5>附：浙江省医院药事管理质控中心、浙江省医学会临床药学分会</FONT></DIV>
<DIV><FONT size=5>双十周年庆典暨2012年临床药学学术年会回执</FONT></DIV>
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<TABLE border=1 cellSpacing=0 cellPadding=0 width=672>
<TBODY>
<TR>
<TD width=84>
<DIV align=center><FONT size=5>姓名</FONT></DIV></TD>
<TD width=48>
<DIV align=center><FONT size=5>性别</FONT></DIV></TD>
<TD width=156>
<DIV align=center><FONT size=5>单位</FONT></DIV></TD>
<TD width=96>
<DIV align=center><FONT size=5>职务/职称</FONT></DIV></TD>
<TD width=98>
<DIV align=center><FONT size=5>电话</FONT></DIV></TD>
<TD width=108>
<DIV align=center><FONT size=5>电子邮箱</FONT></DIV></TD>
<TD width=82>
<DIV><FONT size=5>是否住宿</FONT></DIV></TD></TR>
<TR>
<TD width=84>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=48>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=156>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=96>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=98>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=108>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=82>
<DIV align=center><FONT size=5></FONT> </DIV></TD></TR>
<TR>
<TD width=84>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=48>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=156>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=96>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=98>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=108>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=82>
<DIV align=center><FONT size=5></FONT> </DIV></TD></TR>
<TR>
<TD width=84>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=48>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=156>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=96>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=98>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=108>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=82>
<DIV align=center><FONT size=5></FONT> </DIV></TD></TR>
<TR>
<TD width=84>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=48>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=156>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=96>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=98>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=108>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=82>
<DIV align=center><FONT size=5></FONT> </DIV></TD></TR>
<TR>
<TD width=84>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=48>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=156>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=96>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=98>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=108>
<DIV align=center><FONT size=5></FONT> </DIV></TD>
<TD width=82>
<DIV align=center><FONT size=5></FONT> </DIV></TD></TR></TBODY></TABLE></P>
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