Online Registration

Please complete the form below and make an online membership fee payment for registration.

Membership period year 2024
(Jan 1 - Dec 31)

Member Type:

Life Member ($5000)

Ordinary ($0)

Student (Free)

Principal:

Name (Family_1st_2nd):

1st 2nd

Year of Graduation:

Qualification:

Name Order: Western

Chinese

Home Address:

District:

Region:

Country:

Tel (Work):

Tel (Home):

Fax:

Mobile:

Email:

Clinic / Address :

New Clinic / Address:

Clinic :
Flat / Floor / Building:
Street :

District:

Region:

Country:

Tel:

Fax:

Please enter validation code.