Registration Form 報名表

Step 1: Register Information 報名資訊
Step 2: Accompany Person (If there is no accompany person, please skip this step.) 隨行人員(如沒有隨行人員,即可略過此步驟)
Step 3: Category 身份別
Step 4: Registration Fees/Social Programs 報名費/晚宴
Step 5: Method of Payment 付款方式

Registration No. This is a new Registration
* E-Mail
電子郵件

(E-mail is your ID, please keep it! 電子郵件為您的ID,敬請務必保留)
* Password
密碼

Password (6~12 characters, case sensitive) 6~12英數字元,區分大小寫
* Confirmed Password
請再輸入一次密碼

(please type it again 請再輸入一次密碼)
* First Name 名
(Please fill in ENGLISH 建議以英文輸入相關個人資料)
* Last Name 姓
(Please fill in ENGLISH 建議以英文輸入相關個人資料)
* Title 職稱
* Gender 性別
* Institution/Organization 單位
Postal Address 地址
Post Code 郵遞區號
City 市(無則免填)
State 區域
* Country 國家
* Area code 電話區號
* Telephone/Cellphone number
電話號碼
 Fax 傳真號碼
Only for International Microsurgery Club Premium Membership (International Microsurgery Club Premium Membership 專屬區域)
※ Please skip this if you are not International Microsurgery Club Premium Membership.
※ 若您不是 International Microsurgery Club Premium Membership,請略過此欄位
優惠碼(Promotion Code):
(Please confirm the promotion code.)
Premium Membership Number:
(Please confirm your premium membership number.)

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