| 姓名 Name | | 性别 Sex | | 年龄 Age | | 生日Birthday | | photo | |
| 电邮Email | | 联系电话Telephone | | |
| 职业 Work | | 联系地址Address | | |
| 健康状况自评 | | |
| 紧急联系人 | | 紧急联系方式 | | |
| 选择您所喜爱的户外活动 Select your favorite game | [ ]登山mountaineering [ ] 攀岩climb [ ]漂流 drift | |
| [ ]徒步pedestrianism [ ]划船boating [ ]露营camp | |
| [ ]游泳 swimming [ ]足球football [ ]羽毛球badminton | |
| [ ]篮球basketball [ ]排球volleyball [ ]网球tennis | |
| [ ]乒乓球pingpong [ ]滑雪ski [ ]其他other _______ | |
| 您的兴趣爱好 Your interesting | | |
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| 您是如何知道我们的 How do you know us | [ ]朋友 friends [ ]推荐人 [ ]网 web | |
| [ ]杂志 magazine [ ]电视 TV [ ]报纸 newspaper | |
| 您对我们俱乐部的建议 Your advise for our club | | |
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| 1、我阅读了“穿山豹户外运动俱乐部”章程，我愿意遵守俱乐部对会员的有关规定。 | |
| 2、我自愿加入““穿山豹户外运动俱乐部”，自行承担自助活动中出现的意外事故。 | |
| 1. I have read the constitution of the Csb Ourdoors Club, I am willing to abide any provision for the member. | |
| 2. I am will to be a member of Csb Outdoors Club, I will in charge of the contingency myself in the activities. | |
