201806 TIMA-Canada YNSA Workshop @Toronto Online Registration
First Name (legal name or name on your certificate ) *
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Last Name *
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中文姓名Chinese Name (if applicable)
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研習證書姓名 (Full Name for Certificate) *
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Gender 性別 *
Contact Number *
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Email *
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Your current status in medical profession? *
Practitioner or Student License No.執業醫師或學生註冊號
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Are you a current TIMA Member? 您是慈濟人醫會的成員? *
Language preference (for preparing equipment of translation ) 聽課語言偏好(為方便準備語言翻譯設備) *
Your currently stay *您目前的居住地 *
Join group order for needles purchase 需要代訂針具(SEIRIN 0.16/ 0.20 x15mm, 100'/CAD $17 /box) *
How many Boxs that you want to order (pay at pick up)需代購盒數,取貨付款(請自備零錢)
Your preferred session of live demonstration and free-med service observation義診跟診參加時段調查(因員額限制,工作小組可能調整您能參加的實作時段 the organizer might have to change your session if needed) *
Way to pay付費方式 *
*Pay by Cash:please visit Tzu Chi Foundation West Toronto office in a week for payment現金付款說明:請在完成網路報名後1週內親赴慈濟西多倫多聯絡處繳交報名費( 5555 Eglinton Avenue West, Toronto M9C 5M1)
*Pay by Cheque:please mail or visit Tzu Chi Foundation West Toronto office ( 5555 Eglinton Avenue West, Toronto M9C 5M1)支票付款說明:請在完成網路報名後1週內,將支票郵寄或親自送到慈濟西多倫多聯絡處。支票請開即期日,Payable to:TZU CHI MEDICAL CENTRE OF TRADITIONAL CHINESE MEDICINE FOUNDATION CANADA
*Pay by Credit Card: (1) click點選連結 https://squareup.com/store/tcmc-at-ynsa-t/ (2)choose your item and checkout依您的身分別選擇項目並進行付款 (3)copy and past the order number (4 digits) on the below請將付款完成時得到的交易完成碼(4碼)填寫到下方,以供確認完成繳費之用。 (4)Don't forget come back to submit.別忘了回到本畫面將資料送出喔!
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