姓　　名 ( 請輸入中文姓名，勿超過10個字 )

會員帳號 ( 至少 4 個字， 最多勿超過15個字 )

會員密碼 (至少 4 個字， 最多勿超過20個字 )

確認密碼

E - mail ( 熟客電子報將不定期傳送鮮茶道presotea 門市活動及新商品情報 )

生　　日  年  月  範例：1960年04月05日

行動電話

電　　話 區碼 - 分機

性　　別 男 女

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職　　業

學　　歷