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Membership Application Form
会员申请表

First Name 名字

Last Name 姓氏

Date of Birth 出生日期

Year of Arrival 抵加年份

Status 身份

Visitor Visa 探亲签证

Study Permit 学签

Work Permit 工签

Permanent Residence 移民

Citizen 公民

Gender 性别

Women 女

Men 男

Prefer not to respond 不便回答

Home Phone 住宅电话

Mobile Phone 手机号码

Email 邮箱地址

Address 详细住址加邮编

Emergency Contact 紧急联络人

Relationship 关系

Telephone 紧急联络人电话

How do you know ICANSA? 你是如何知道零基础的？

I have received, read, understood, and agreed the attached Waiver. 我已收到、阅读、理解、并同意附件的免责同意书。View waiver 点击这里查看免责声明

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Date 日期

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FAQ

ICAN Seniors Association

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