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Registration Form

Fields marked (*) are compulsory

A: PERSONAL PARTICULARS
Salutation: *             Gender: *  
Full Name: *
 Date of Birth: *
Correspondence Address: *
State: *
 Country: *
Postal Code: *
Contact Number: *
 Mobile Number: (Optional)
 Facsimile Number:
Email Address: *
 Institution: *
 Specialty: *
Are you the APOA/APSS Existing Member?: *  
B: REGISTRATION FEES
Category Amount Payable
USD 300
USD 400
TOTAL (USD)
Please enter the text as below *
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