MEMBERSHIP REQUIREMENTS . APPLICATION FORM
$ 50 for individual membership for 5 years

$ 100 for lifetime membership

$ 200 for Society membership for 5 years

BANK DRAFT Payable To :

ASPID OR ASIAN SOCIETY FOR PEDIATRIC INFECTIOUS DISEASES
Account # : 200-710787-3
Philippine National Bank
Corner PGH, Taft Avenue Manila
1000, Philippines

BANK TRANSFER MONEY  To :

Siam Commercial Bank Public Company Limited
Name: ASPID by Dr. Pornthep Chanthavanich and Dr. Usa Thisyakorn
Account Number: 254-204724-3
Savings account
Swift code: SICOTHBK

BANK DRAFT Made To :

ASPID by Dr. Pornthep Chanthavanich and Dr. Usa Thisyakorn  

and send the letter to 

Dr. Pornthep Chanthavanich
29 Pradipat 23Phyathai
Bangkok 10400,Thailand

Application Form
DATE OF APPLICATION:
FAMILY NAME FIRST NAME MIDDLE NAME
SEX BIRTHDATE
MALE DAY MONTH YEAR
FEMALE
MAILING ADDRESS
OFFICE PHONE
OFFICE FAX
OFFICE EMAIL
HOME ADDRESS
HOME PHONE
HOME FAX
HOME EMAIL
Present Position/Affiliation
Institution/Hospital
Address
Medical Organization/Society Affiliation
Specialty & Subspecialty
Summary of Research Papers/Publications
 

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