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?                            $250 US

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

   Fellow/Member - Scientist                                            $200 US

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

   Fellow/Member-Nursing-Allied Health                       $200 US

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

   Student                                                                          $50 US

     (Online access of the journal Photomedicine and Laser Surgery)

   WALA Non-Journal Membership                                 $50 US

   WALA Institutional Membership                                $300 US

                                                               

Mode of Payment:

   Bank Transfer order to:      

 Al-Rajhi Bank, Riyadh, Saudi Arabia

Account No. SA5380000114608010246182 IBAN

 Swift Code: RJHI SARI


   Note: If you do not receive a reply, Please send Email to membership@laser-wala.com