世针针灸学会联合会国际针灸专业人员水平考试申请表
Application Form for International Qualification Test for Acupuncture and Moxibustion Practitioners of WFAS
NO.号
报考专业(Specialized Subject of Examination):
1.姓名/Name:
2.性别/Sex: 男 (Male) 女 (Female):
3.出生日期/Date of Birth:
报考语种/Language for Examination:
4.国籍或地区/Nationality or Region:
5.护照号/Passport No. :
6.通讯地址/Contact Address:
7.电话/Tel: 传真(Fax):
8.医/药、护理 学历/学位:Medical Education and Academic:
中专 Secondary School 大专 Junior College 本科 Junior College 硕士 Master Degree 博士 Doctor Degree
9.何时在何院校(或学术团体)学习中医(中药、中医护理)/ Studied TCM at what Time and which Organization (or Association) :
学习培训时数/Learning Hours:
临床实践时间/Practicing Hours:
10.从师学习/Studying TCM As an Apprentice:
指导医师姓名/ Master's Name:
国籍或地区/Nationalityor Region:
专业职务/Professional Position:
从事学习年限/Period of Apprenticeship:
从业多年,确有专长/Practicing Medicine for Many Years with Specialty:
11.从业年限/Practicing Years:
12.身份证明、学历证明(影印本)名称/Titles of Certificates ( duplicated copies ) for Reference :
申请人签字(Applicant's Signature):