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IACMSP国际华人医学家心理学家联合会

International Association of Chinese Medical Specialists & Psychologists


四川汶川512地震灾后心理援助志愿者报名表


填表日期:                                    (请附上个人登记照片)


报名类别(请划“√“):心理援助专家(        );心理援助专家助理(        )

姓名                                                      (英文拼写)                                                    

性别                    出生日期                    年                                  日                  出身地(市)                  国籍                

专业                                                 最高学历                                                 职务(职称)                                               

工作机构及通讯地址                                                                                                                                                               

                                                                                                                                                                                                   

电话(办)                                                 电话(家  )                                               手机                                               

传真                                                 E-mail                                                                                            

简历及专长:






您的工作计划:






参加志愿者工作的时间和地点(自选):



(以下由IACMSP常务理事会填写)


常务理事会意见                                                                 理事长签字                                                                       

Tel:(718) 820-9320; (917) 402-7176

Web: www.iacmsp.org    E-mail: iacmsp@gmail.com

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