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North America Federation of Overseas Chinese Associations

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Individual Membership Application Form

Last Name(Ó¢ÎÄ)ÐÕ:

First Name(Ó¢ÎÄ)Ãû:

Gender(ÐÔ„e):

Nationality(‡ø¼®):

Age(Äêýx):

Religious Belief
(×Ú½ÌÐÅÑö):

Service Institution
(ËùÔÚÉçˆFÃû·Q):

Position(ÂšÎ»):

Residency(±¾ÈËËùÔÚµØ)¡G

City(ÊÐ):

Province(Ê¡):

Country(‡ø¼Ò):

Address(Í¨ÐÅµØÖ·):

Post Code(à]¾Ž):

Fax(‚÷Õæ):

Telephone(ëŠÔ’):

E-mail(ëŠ×Óà]¼þ):

Mobile Phone Number
(ÊÖÌáëŠÔ’):

Web Site(¾WÕ¾):

Company
(±¾ÈËËùÔÚ¹«Ë¾¼¯ˆF):

Position(ÂšÎ»):

Industry ¹«Ë¾(¼¯ˆF)
ËùÉæ¼°µÄ½›úîIÓò»ò·þ„Õ:

Personal Statement
(‚€ÈËº†½é):

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The undersigned hereby applies for membership of the North American Federation of Over Seas Chinese Associations and certifies that all statements made above are correct¡C

Signature(ºžÃû):

Date(ÈÕÆÚ)£º