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Membership

Membership Application Form (for Personal Registration)


Notice

  • To apply for membership you need to fill out this form and send it. Without the requested document we are not able to process any membership application. * is the required item.
  • The annual fee for membership of AASD is 100USD (10,000JPY for Japanese) and for graduate student / clinical resident is 50USD (5000JPY for Japanese), including the subscription fee for JDI.
  • The application procedure will be completed after AASD office verifies your deposit slip of annual fee.
  • Payment using credit card is highly recommended. Please note that, no bank transfer is available from countries other than Japan.
  • Membership is automatically renewed. Unless you notify withdrawal from AASD, you will be automatically charged with annual fee on the date of renewal. For member’s paid via bank transfer, the office will send notice before the renewing date.


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Title
First Name*
Family Name*
Date of Birth (dd/mm/yyyy)* Date:   Month:   Year:
Institute/Company Name*
Membership* Ordinary : 100USD (10,000JPY)
Graduate Student/Clinical Resident:50USD(5,000JPY)
Payment* Credit card (for residents not in Japan)
Credit card (for residents in Japan)
Bank transfer (Japan only)
Address : This address will be used for the mailing of JDI, receipt, membership ID, etc.
  Office or Home* Office Home
  Street*
  Postcode*
  City*
  Country*
Tel*
Fax
E-mail*
E-mail(RE)* Please input same E-mail.
Present Position

Qualifications



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