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["附件"]
["甘肃省中医药学会会员登记表                                                                        1                                          拟推荐专业：     专业委员会"]
["姓名",null,null,"性别",{"$nulls":4},"出生年月",{"$nulls":4},"照              片"]
["籍贯",null,null,"民族",{"$nulls":4},"党  派"]
["技术职务",{"$nulls":4},"现从事专业"]
["行政职务",{"$nulls":4},"外语及程度"]
["工作单位",{"$nulls":7},"所在地区"]
["单位地址",{"$nulls":4},"电话",{"$nulls":5},"邮编"]
["家庭地址",{"$nulls":4},"电话",{"$nulls":5},"身体状况"]
["毕业名称",{"$nulls":7},"毕业时间",null,null,"学 位",null,null,"学 历"]
[]
[]
["研究生（硕士、博士）导师",{"$nulls":3},"是   否",null,null,"目前状况",null,null,"在职  离退休  其他"]
["哪级、哪届人大代表、政协委员"]
["依据《甘肃省中医药学会章程》，会员收费标准为300元/人/5年。"]
["工作    简历"]
["科研成果及   获奖情况","国家级",null,"部级",{"$nulls":4},"省级",{"$nulls":3},"地（市）级"]
[]
["本表为正面，填完务必填写背面。"]

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["发表的主要著作及论文",null,"论文（著作）出版",null,"出版、登载、获蒋或在学术会议上的交流情况",null,null,"发表             日期",null,"合（独）      著、译著"]
[]
["进修                        情况"]
["学  会  任 职","理事会","中华中医药学会             （届次、职务）",null,"省中医药学会             （届次、职务）",null,null,"地、市中医药学会（届次、职务）",null,"其他学会（届次、职务）"]
[]
[null,"工作委员会"]
[null,"专业委员面",1]
[null,null,2]
[null,"编委会",1]
[null,null,2]
["单位推荐意见","（盖      章）                                                                                              年     月     日        "]
["填完后请按文件要求推荐，由专业委员会统一办理会员证。"]