MEMBERS .--->Electrical Engineering Academic Association of THAILAND

1. Personal Information

Title :

First Name :

Last Name :

Middle Name :

(IN THAI) :

(IN THAI) :

Date of Birth >>

Month:

Date:

Year:

Nationality :

Religion :

2. Address

City : Telephone :

State/Province : Mobile phone :

Country :

Fax :

Zipcode :

E-mail :

3. Address (workplace) >> If the same as in 2. please choose.

City : Telephone :

State/Province : Mobile phone :

Country :

Fax :

Zipcode :

E-mail :

4. Subscribe category

Associate:

Student:

"I hereby certify that the above information is correct."