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Apply for Regular Membership

Please fill in the required information and click the Submit button.

    Name (Required)

    Date of Birth (Required)

    Year/Month/Day

    Year of Graduation (Required)

    Year/Month（e.g., March 2000）

    Workplace

    Institution Name:

    Department/Division:

    Job Title:

    Address:

    Phone Number:

    Home Address

    Address:

    Phone Number:

    Preferred Mailing Address

    WorkplaceHomeOther

    Qualifications (check all that apply)

    PhysicianPharmacistRegistered DietitianDietitianNurse

    Other:

    Email Address (Required)

    Confirm Email Address (Required)


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