CMAAC STUDENT MEMBER APPLICATION FORM ~ CMAAC  學生會員申請

 

Personal Details 個人信息

Last name 姓: __________________________   First name 名: __________________________

Chinese name 中文姓名: __________________________           Gender 性別: ___________________

Date of Birth (dd/mm/yy) 出生日期: ______/______/______

Citizenship 國: __________________________             Resident Status籍: _________________________

Home address 家庭住址: ____________________________________________________

City 城市: __________________________ Prov 省份: __________ Postal Code 郵政編號: ________________

Home phone 家庭電話: ________________________ Cell phone 手機: ____________________________

Email address 郵箱地址: ________________________________________________

Would you like to receive the CMAAC eNews? 你希望收到CMAAC的電子新聞嗎?

Yes 是 ð   No 否 ð (you can opt out at anytime可以隨時取消接受電子新聞)

Email address 電子郵箱地址: ____________________________

 

R.Ac / R.TCMP Details 教育經歷

School attended 目前所在機構: ________________________________________________

Expected Graduation or Completion Date 預計畢業日期: (dd/mm/yy， 日/月/年) ______/______/______

Pan-Canadian Exam date (Pan-Canadian考試日期): ______/______/______

Expected licencing date (預計取得執照日期): ______/______/______

ð I hereby apply to be admitted as a Student Member of CMAAC and agree to be bound by the provisions of the Association Bylaws and the Code of Ethics of the Association. I understand that the role of a Student Member of CMAAC is to support the mandate of CMAAC: networking, promoting, and being involved in professional matters that affect the TCM profession.

我特別作爲學生會員加入CMAAC，并且同意遵守協會章程及協會道德守則。我理解作爲一名CMAAC學生會員，要遵從CMAAC的指導：交流，促進，積極參加TCM專業活動。

ð I am aware that a complimentary Student Membership requires me to do some volunteer work for CMAAC我了解作爲免費的學生會員，我需要為CMAAC做志願者工作。

ð A student member of the Association does not authorize me to engage in the unsupervised or unauthorized practice of acupuncture and/or Chinese Medicine.

作爲一名協會的學生會員，我不允許參加無人監管或者無人授權的中醫藥及針灸實踐活動。

ð I have previously been suspended, expelled, deregistered from a professional association or national registration board for breach of professional ethics or practice standards.

我曾因爲違反職業道德和行爲守則被專業機構或國内注冊機構除名，開除。

Please give details 請具體陳述: ________________________________________

ð The above-mentioned details are true and correct to the best of my knowledge

以上的信息在我所知範圍内真實準確。

 

 

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Signature    簽名                                                                                                                        Date 日期

 

For Office Use Only 内部使用:

Qualified 會員資質(y/n) _______ Membership # 會員號: _________ Date: ______/______/______ Authorized: __________