Application Form

for the American Association of Fujian Medical University Alumni

Please read AAFMUA's Bylaws and Membership fee information first if you have not done so yet. Thanks!

(Required fields are denoted by *s. The form will not be submitted unless all the required fields are filled. Thanks!)

Prefix: Dr. Ms. Mrs. Mr.
First Name: *
名: (Chinese Given Name)
Last Name: *
姓: (Chinese Family Name)
  　 　
Mailing Address 　 　
Street Address:
Street Address:
City:
State or Province: *
Zip Code or Postal Code:
Country or Region:
Day Phone Number -- Area Code: Number:
Night Phone Number -- Area Code: Number: *
Fax Number -- Area Code: Number:
Email: *
Alternative Email:
  　 　
Experience in
Fujian Medical University
or its affiliated hospitals		 　 　
Year in Which You Graduated from
the Med School:
Year in Which You Graduated from
the Postgraduated Studies:
Worked from -- Year: to:
  　 　
Current 　 　
Organization:
Work Address:
Work Adress:
Department or Division:
City:
State or Province:
Zip Code or Postal Code:
Country or Region:
  　 　
Are you available for
AAFMUA volunteer service? 		Yes Sorry, but no
if yes, when?
Comments:

This form is updated July, 7/13/2008. If you encounter any problem with it, please contact Webmaster.

You are also welcome to print this form. Fax it to AAFMUA after completion at 205 449 0909.

aafmua