NAME AND SURNAME:

T.R. ID NO:

FATHER'S NAME:

MOTHER'S NAME:

PLACE/DATE OF BIRTH:

GENDER:

MAIDEN NAME:

GRADUATED FROM:

YEAR OF GRADUATION:

GERIATRIC REHABILITATION STUDY AREA:

IDENTITY CARD INFORMATION

CITY/COUNTY:

NEIGHBORHOOD /VILLAGE:

BINDING NO:

FAMILY ROW NO:

ORDER NO:

DATE GIVEN:

EXPORTED FROM:

IDENTITY CARD NO:

SERIAL NO:

BUSINESS ADDRESS:

HOME ADDRESS:

AFIELD OF COMMUNICATION:

HOME:›

WORK:›

HOME PHONE:

0.(      ) ... .. ..

WORK: 0.(      ) ... .. ..

MOBILE: 0.5.. ... .. ..

E-MAIL

I want to become a member of the Geriatric Physiotherapists Association.

I agree to fulfill all the conditions and documents required by the membership and to pay the dues of the association.

I would like to request that the necessary action be taken.

SIGNATURE

Required Documents:

q  Copy of Diploma or Exit certificate.

q  2 Pictures

q  Photocopy of Identity Card

Association Account No: Yapı Kredi Bankası Hacettepe Branch: 71094589

IBAN: TR76 0006 7010 0000 0071 0945 89

INFORMATION FORM

1-Your subject of study in the field of geriatric rehabilitation:

2-The institution you are currently working for:

3-The institution where you worked on the previous geriatric rehabilitation:

4-Your studies on geriatric rehabilitation

-Project:

-Clinic Works:

-Search Area (article or paper)

-Field Work:

-Specific Activities:

-Other:

5-Institutions and organizations you are associated with in the field of geriatrics

6-National and international congresses and courses you attend in the field of Geriatric Rehabilitation

7-Your thoughts and suggestions about the Geriatric Physiotherapists Association:

8- Contributions you can give to the Geriatric Physiotherapists Association: