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IASPM-SEA Membership Application Form
All information and answers collected in this form will be kept strictly confidential and used only for the purposes stated therein.
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* Indicates required question
Email
*
Your email
Last name
*
Your answer
First, second, middle Name
*
Your answer
Contact number
For IASPM-SEA Telegram group
+(country code) (mobile code) (number)
+60 12 3456789
Your answer
Country of residence
*Write N/A if you prefer not to disclose
*
Your answer
Institutional affiliation
*Write N/A if not applicable
*
Your answer
Designation
*Write N/A if not applicable
*
Your answer
Membership fee category
*
Waged
Unwaged/Student
Membership year paid for
*
Your answer
Payment method
*
Wise
PayPal
Payment date
*
MM
/
DD
/
YYYY
Payment reference number (Wise or PayPal)
*
Your answer
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