Membership Type** Full Membership (Private Practice Specialist)* Affiliate Membership (NON-Private Practice Specialist) Surname* Given Name (in full)* Chinese Name Title Date of Birth01020304050607080910111213141516171819202122232425262728293031day / JanuaryFebruaryMarchAprilMayJuneJulyAugustSeptemberOctoberNovemberDecembermonth / 20192018201720162015201420132012201120102009200820072006200520042003200220012000199919981997199619951994199319921991199019891988198719861985198419831982198119801979197819771976197519741973197219711970196919681967196619651964196319621961196019591958195719561955195419531952195119501949194819471946194519441943194219411940193919381937193619351934193319321931193019291928192719261925192419231922192119201919191819171916191519141913191219111910190919081907190619051904190319021901year GenderMaleFemale Office Tel. Office Fax Address Office address District Email* Mobile* Degree and qualificationsDegree or QualificationName of InstitutionYear Obtained Specialty Special area of interest%23 - Scanned copy of applicant's signature (click to upload)%You may create an electronic signature at this website, save the image file to your computer, and upload it here. Alternatively, please scan and upload a handwritten signature.* Mandatory fields.SubmitReset
