1. Taiwan Anti-Aging Association Membership Application Form
Taiwan Academy of Anti-Aging
Tel： 　Fax：
Taiwan Anti-Aging Association
Membership Application Form
No____________
Name
Sex
□ Male　　　□ Female
Birth day
　/　 / 　 (day/month/ year)
Tel
Fax
Cell Phone
Address
Address
Education
Experience
Present Occupation
Present Title
Applicant Sign：
＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿＿
Date:　　　　　　　(day/month/ year)
Fee (USD)
Application Fee ７０　USD
Yearly Fee ４０　USD
1 Wire the fee to the following account
Bank: Taishin International Bank, Taiwan
(Swift Code: TSIBTWTT )
Account No:
Account Name: The Taiwan Academy of Anti-Aging Medicine
2 Fax the receipt or invoice to T3A.