*
Title
-- Please Select --
Prof
A/Prof
Dr
Mr
Mrs
Ms
*
Name
*
Date of Birth
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Year
1901
1902
1903
1904
1905
1906
1907
1908
1909
1910
1911
1912
1913
1914
1915
1916
1917
1918
1919
1920
1921
1922
1923
1924
1925
1926
1927
1928
1929
1930
1931
1932
1933
1934
1935
1936
1937
1938
1939
1940
1941
1942
1943
1944
1945
1946
1947
1948
1949
1950
1951
1952
1953
1954
1955
1956
1957
1958
1959
1960
1961
1962
1963
1964
1965
1966
1967
1968
1969
1970
1971
1972
1973
1974
1975
1976
1977
1978
1979
1980
1981
1982
1983
1984
1985
1986
1987
1988
1989
1990
The birthdate will be used as verification, should you forget
your password.
*
Gender
Male
Female
Nationality
*
Qualifications
eg. MBBS (Australia) 1972, MRCP (UK) 1976
*
Category
Physician
Non-physician/ Others
If
Physician,
-- Please Select --
Nuclear Medicine Physician
Cardiologist
Radiologist
Other Medical Specialty
Other Specialty, please specify:
If
Non-physician/ Others,
-- Please Select --
Physicist/ Scientist
Radiographer/
Nuclear Medicine Technologist
Radiopharmacist
Nurse
Others
Others, please specify:
Designation
Department
*
Hospital
*
Mailing Address
Postal
Code
City
State
*
Country
-- Please Select --
Australia
Bangladesh
China
Hawaii
Hong Kong (China)
India
Indonesia
Iran
Japan
Korea
Malaysia
Nepal
Pakistan
Philippines
Singapore
Sri Lanka
Taipei (China)
Thailand
Trinidad
Vietnam
Others
Telephone
(please include country and area code)
*
Fax
(please include country and area code)
*
Email
*
Password
(6-8 characters, both alpha and numerical)
The userid of your membership will be issued by the APSNC Secretariat.
You may choose your password - do remember it well.
Preferred
Mode of Contact
-- Please Select --
Email
Fax
Mail
Promotional
Materials
From time to time, we anticipate that we may be approached by commercial
companies to contact doctors and other health-related personnel
for the purpose of advertising material. Our strict policy is that
we will not disclose any contact addresses or information without
any prior agreement from the member. However, if you wish to receive
such material, please let us know by indicating in the space below:
Yes, I wish to receive such promotional materials.
No, I do not wish to receive such promotional materials.
I have read and understood the Criteria
for Joining APSNC .
I shall post my entry ONCE only.