Registration Form 欧洲浮针医学会会籍登记表

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* Please ensure that you have paid £100 membership subscription fees and you have a reference of that payment available before filling this form. All * sections have to be filled otherwise the form will not be able submitted. If you have not paid the subscription fee, please find the necessary bank details hereunder:
Bank Name: Barclays; Account Name: FSNAE;
Sort Code: 20-17-20; Account No.: 90959936.
IBAN: GB80 BUKB 20172090959936

* 填表之前，请确认你已经从银行转付了100英镑会费，并记录了付款编号。所有带*的部分必须填上，否则表格将无法上传。如果你还没有付会员费，请从银行直接转帐。
银行资料：Bank Name: Barclays; Account Name: FSNAE;
Sort Code: 20-17-20; Account No.: 90959936.
IBAN:GB80 BUKB 20172090959936
SWIFTBIC: BARCGB22

Email *

Untitled Title

Fu's Subcutaneous Needling Association of Europe

Last Name 姓 *

First Name 名 *

Gender 性别 *

女 Female

男 Male

Nationality 国籍 *

Date of Birth 出生日期 (月，日，年） *

YYYY

Mailing Address 通讯地址（并非行医地址） *

Post Code 邮政编码

Country 所在国家 *

Telephone 电话 *

Mobile 手机 *

WeChat 微信号

Main Practice Address 主要行医地址（将在网站上公布） *

邮政编码

诊所电话

Practice 2 行医地址2

Post Code 邮政编码

Practice telephone 诊所电话

FSN training details（Date/venue/trainer): 浮针培训情况（时间/地点/培训者 *

Please state the name of your professional body 请注明你所加入的专业团体名称

BAcC

ATCM

RCHM

Other:

Clear selection

Please state your public liability insurance 请注明你的行业保险情况 *

I have stopped practice and hence no need to have public liability insurance.

I have already arranged my own practice

Please state your public liability insurance company name 请注明你的行医保险公司 *

With ATCM

With BAcC

Other

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