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APPLICATION FORM FOR MEMBERSHIP OF WORLD FEDERATION OF ACUPUNCTURE-MOXIBUSTION SOCIETIES

作者:超级管理员 来源:本站原创 点击:188次 更新:2017-06-26

APPLICATION FORM FOR MEMBERSHIP OF WORLD FEDERATION OF ACUPUNCTURE-MOXIBUSTION SOCIETIES
 
 
 
Secretariat use only
 
Reg. No.:
 
Date Received:
 
 
 
Please complete this form and return it to:
 
WFAS Secretariat(16 Nanxiaojie, Dongzhimennei, Beijing 100700, China)
 
 
                                        
Name of applicant                                           
 
 
Date of Application                                            


 
Information of applicant
 
 
English Name                                                          
 
Chinese Name                                                        
                         
Country / Region                                                     
 
Date of founding                                                          
 
Authorities of organization registered with:
 
                                                                      
 
Total Number of Members                                               
 
Number of Doctors of Acupuncture and TCM                             
 
Number of Western Medicine Doctors with Certificate of Acupuncture
    _______________________________________________________
 
Number of Acupuncturists                                            
 
Number of Other Researchers or Students related with Acupuncture       
 
 
Name of President                                                      
 
Term of post (Year to Year)                                          
 
Mailing Address                                                    
 
                                                                     
 
Tel:                   Fax:                E-mail:               
 
 
Name of Liaison Person                                                  
 
Mailing Address                                                    
 
                                                                  
 
Tel:                   Fax:                E-mail:               
 
 
Permanent Mailing Address of Organization                                
 
                                                                     
 
Tel:                   Fax:                E-mail:               
 
Web Site                                                                  
 
 Is there any sub-parties of your society?
                                                  Yes □  No□
 
Name of the sub-parties                                                       
 
                                                                      
                                                 
                                                                      
 
                                                                      
 
                                                                      
 
 
 
 
 
 
Date                                   Signature                           


 
Brief Introduction to the History and Academic Activities Related to Acupuncture of the Applicant


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