MemberShip Application

 

                                              Membership Application

 

  Full Name (First, Middle, Last)        

  Proffession                                            

  Institution                                            

  Address                                                                                      

  Postal code/Zip                                  

  Country                                                

  Contact phone                                  

  Mobile No.                                         

  E-mail                                                

 

                                                    Membership Categories & Dues:

   Fellow/Member-Physician-Industry                             $200 US

    (includes the new-bi-monthly journal Photomedicine and Laser Surgery)

   Fellow/Member - Scientist                                            $150 US

    (includes the new-bi-monthly journal Photomedicine and Laser Surgery)

   Fellow/Member-Nursing-Allied Health                       $150 US

    (includes the new-bi-monthly journal Photomedicine and Laser Surgery)

   Student                                                                          $30 US

     (Online access of the journal Photomedicine and Laser Surgery)

   WALA Non-Journal Membership                                 $50 US

   WALA Instittutional Membership                                $250 US

                                                               Mode of Payment:

   Bank Transfer order to:      

                                          Al-Rajhi Bank, Riyadh, Saudi Arabia

                                               Account No. 114 6080 102 46182