Online Registration

Membership period year 2017
(Jan 1 - Dec 31)

Member Type:
Life Member ($5000) Ordinary ($500)
Principal :
Name (Family_1st_2nd) :
  
1st  2nd
Year of Graduation :
Qualification :

Clinic / Address :
New Clinic / Address :
Clinic :

Flat / Floor / Building :

Street :
District :
Region :
Country :
Tel :
Fax :
Name Order : Western  Chinese
SMS to Mobile : Yes  No
Other Name / Address :


District :
Region :
Country :
Tel (Work) :
Tel (Home) :
Fax :
Mobile :
Email :