Membership Renewal Form
AFPS Individual Member
* Required
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| *Member ID: |
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| Country Category: |
Category A /
Category B /
Category C |
| Student: |
Yes /
No |
Annual Fees
In the meantime, fees will be charged in JPY calculated at the USD/JPY TTS rate as of January 1 of the fiscal year. (For members in Japan, USD 1 is considered as JPY 100)
Class |
Category |
Annual Fee |
Individual Member |
A |
USD 90 (Students: USD 45) |
B |
USD 60 (Students: USD 30) |
C |
USD 30 (Students: USD 15) |
Country Categories
A (high-income) |
Australia, Hong Kong (China), Japan, Korea, Malaysia, Singapore and Taiwan (China) |
B (middle-income) |
China, Egypt, Fiji, India, Iran, Nepal, Philippines, Sri Lanka, Thailand and Tonga |
C (low-income) |
Afghanistan, Bangladesh, Bhutan, Indonesia, Iraq, Pakistan and Viet Nam |
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| *Check the appropriate box: |
Ms. /
Mr. /
Dr. |
| *Family Name: |
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| *Given Name: |
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| Gender: |
Male /
Female |
| *Date of Birth: |
(YYYY/MM/DD) e.g. 1970/01/10 |
| The address listed is: |
Business /
Home |
| Company/Institution:
(nonbreaking) |
e.g. Dept. of Pharm. Sci., Univ. of ***** |
| Address, City, State, ZIP: (nonbreaking) |
e.g. 123 Medicine St., Bunkyo, Tokyo 113-0000 |
| Country: |
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| *Email: |
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| *Retype Email: |
please enter the same Email address as above. |
| Telephone Country Code: |
+
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| Telephone: |
(e.g. 3-5400-XXXX) |
| Fax: |
(e.g. 3-5400-XXXX) |
| Withdrawal: |
If you are sure to withdraw AFPS, check the box below.
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