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["2014年“西部大讲堂·历史学论坛”报名登记表 "]
["序号","姓    名","性别","单位名称及地址","邮政编码","学员类别（相应栏中画“√”）",null,null,"联系方式",null,"性质"]
[{"$nulls":5},"高校教师","博士生","专业","电话","电子邮箱","（正式或旁听）"]
[1]
[2]
["注：1、请在登记表内注明联系者的姓名、地址、电话和电子邮件等内容。"]
["        2、因名额有限，各单位只可以推荐1到2名正式学员(全日制高校历史学专业青年教师和博士研究生)。"]
["        3、如因一所学校有多名学员报名，正式学员名额最终由“西部大讲堂·历史学论坛”组委会确认。"]
["        4、请学员报到时，必须携带相关证件（身份证、学生证或工作证）证件不齐将取消正式学员资格。"]
["        5、“西部大讲堂·历史学论坛”组委会联系方式"]
["    联系人：曹  伟             电  话：029—85310123"]
["    传  真：029—85310127      E-mail：caowei@snnu.edu.cn"]
["    地  址：陕西省西安市长安区西长安街620号陕西师范大学历史文化学院"]
["    邮  编：710119"]

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