| 北美宁夏同乡会和宁夏医学院校友会登记表 | |||
| North American Ningxia Association and North American Alumni of Ningxia Medical College Registration Form | |||
| Name 姓名 | Gender 性别 | ||
| Address 地址 | |||
| Home phone 家庭电话 | |||
| Office phone 工作电话 | (Option) | ||
| E-mail 电子信箱 | |||
| Ningxia experiences 宁夏经历 | |||
| American experiences 北美经历 (Option) | |||
| Suggestion & Comment 建议 | |||
| 本会郑重声名： 所有会员信息仅用于会员间联系，决不用于任何其它目的。 | |||