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Membership

AASD Individual Membership Application Form


Notice

  • To apply for membership, fill out this form. * is a required item.
  • The application procedure will be completed when the AASD office verifies your payment of the annual membership fee.
  • Credit card payment is required. Please note that bank transfer is ONLY for members living in Japan.
  • Membership is automatically renewed unless you notify AASD of cancellation.
  • The annual membership fee will be charged to the credit card used the previous year.
  • The AASD office will remind you of renewal and payment before the due date via e-mail. Please register your main e-mail address accurately.
  • The AASD office will issue receipt in PDF format for your payment via e-mail.
  • If you have any questions, please contact the AASD Office at office@aa-sd.org


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Title
First Name*
Family Name*
Date of Birth (dd/mm/yyyy)* Date:   Month:   Year:
Institute/Company Name*
Membership* Professional I (Ordinary): 100USD (10,000JPY)
Professional II (Student / Clinical Resident / Paramedical):
   50USD(5,000JPY)
Associate (not living in high income countries):30USD
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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