世界针联入会申请表下载

世 界 针 灸 学 会 联合 会

入会申请表格

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

秘书处专用

Secretariat use only

注册编号.: Reg. No.: 收件日期: Date Received:

请填写此表并寄回到：

Please complete this form and return it to:

世界针联秘书处（北京市东直门内南小街16号，100700，中国）

WFAS Secretariat（16 Nanxiaojie, Dongzhimennei, Beijing 100700, China）

申请者名称：                                         

Name of applicant                                     

申请日期：

Date of Application                                    

申请者的相关情况

Information of applicant

英文名称

English Name                                                 

中文名称

Chinese Name                                                

所属国家及地区                           

Country / Region                                              

创建日期

Date of founding                                              

机构注册情况或所属上级单位：

Authorities of organization registered with:

成员总人数

Total Number of Members                                      

针灸、中医医师人数

Number of Doctors of Acupuncture and TCM                           

获得针灸证书的西医医师人数

Number of Western Medicine Doctors with Certificate of Acupuncture

    ________________________________________________

针灸师人数

Number of Acupuncturists                                       

其它与针灸有关的研究人员或学生人数

Number of Other Researchers or Students related with Acupuncture       

负责人姓名

Name of President                                                

任职期限

Term of post (Year to Year)                                    

通信地址

Mailing Address                                               

电话                  传真                电子邮件

Tel:                   Fax:                E-mail：             

联系人姓名

Name of Liaison Person                                         

邮件地址

Mailing Address                                                

电话                  传真                电子邮件

Tel:                   Fax:                E-mail：             

永久通讯地址

Permanent Mailing Address of Organization                        

电话                  传真                电子邮件

Tel:                   Fax:                E-mail：          

    网址：

Web Site                                                   

你们机构是否包括几个下属团体

 Is there any sub-parties of your society?

                                                  Yes □  No□

下属团体的名称

Name of the sub-parties                                       

日期                                   签章

Date                                   Signature                           

申请者的简史及开展针灸学术活动情况

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

请附上一些必需文件的复印件：包括机构章程、注册证明和有关出版物

Please enclose the copies of necessary documents including constitution, registration certificate, and publications.