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<P style="TEXT-ALIGN: left"><STRONG><SPAN style="FONT-SIZE: 18pt"><U></U></SPAN></STRONG><SPAN style="FONT-SIZE: 11pt"> </SPAN><SPAN style="FONT-SIZE: 12pt"><STRONG><U><FONT color=#57048c><SPAN style="FONT-SIZE: 11pt">정회원 등업 요청서(아래에 작성해 주세요)</SPAN></FONT></U></STRONG></SPAN></P>
<P style="TEXT-ALIGN: left"><SPAN style="FONT-SIZE: 12pt"><STRONG><U></U></STRONG></SPAN> <SPAN style="FONT-FAMILY: Dotum"><FONT style="BACKGROUND-COLOR: #ffffff" color=#000000 size=3><SPAN style="FONT-SIZE: 11pt">1. 성별(남성, 여성) :여성 </SPAN></FONT></SPAN> </P>
<P style="TEXT-ALIGN: left">2<FONT style="BACKGROUND-COLOR: #ffffff" color=#000000 size=3><SPAN style="FONT-SIZE: 11pt">. 사는 도시 혹은 지역(서울,부산,대구,국외 등) :강원도 원주 입니다 </SPAN></FONT></P>
<P style="TEXT-ALIGN: left"><SPAN style="FONT-FAMILY: Dotum"><FONT style="BACKGROUND-COLOR: #ffffff" color=#000000 size=3><SPAN style="FONT-SIZE: 11pt">3. 무엇에대한 정보(갑상선암/항진증/저하증/인터넷정보/여행정보/컴퓨터정보)때문에 가입했나요? :</SPAN></FONT></SPAN><SPAN style="FONT-FAMILY: Dotum"><FONT style="BACKGROUND-COLOR: #ffffff" color=#000000 size=3><SPAN style="FONT-SIZE: 11pt"> 항진증 </SPAN></FONT></SPAN></P>
<P style="TEXT-ALIGN: left"><SPAN style="FONT-FAMILY: Dotum"><FONT style="BACKGROUND-COLOR: #ffffff" color=#000000 size=3><SPAN style="FONT-SIZE: 11pt">4</SPAN></FONT></SPAN><SPAN style="FONT-FAMILY: Dotum"><FONT style="BACKGROUND-COLOR: #ffffff" color=#000000 size=3><SPAN style="FONT-SIZE: 11pt">. 질병인 경우 병명/발병연도(예: 갑상선암/2008년1월) : 1999 </SPAN></FONT></SPAN></P>
<P style="TEXT-ALIGN: left"><SPAN style="FONT-FAMILY: Dotum"><FONT style="BACKGROUND-COLOR: #ffffff" color=#000000 size=3><SPAN style="FONT-SIZE: 11pt">5</SPAN></FONT></SPAN><SPAN style="FONT-FAMILY: Dotum"><FONT style="BACKGROUND-COLOR: #ffffff" color=#000000 size=3><SPAN style="FONT-SIZE: 11pt">. (질병인 경우) 현재 다니는 병원 이름:</SPAN></FONT></SPAN> <SPAN style="FONT-FAMILY: Dotum"><FONT style="BACKGROUND-COLOR: #ffffff" color=#000000 size=3><SPAN style="FONT-SIZE: 11pt"> 손경수내과 </SPAN></FONT></SPAN></P>
<P style="TEXT-ALIGN: left"><SPAN style="FONT-FAMILY: Dotum"><FONT style="BACKGROUND-COLOR: #ffffff" color=#000000 size=3><SPAN style="FONT-SIZE: 11pt">6. 다니는 병원의 방사성동위원소 입원실 숫자(없음,1,2,3,4,5,6...혹은 모름): </SPAN></FONT></SPAN></P>
<P style="TEXT-ALIGN: left"><FONT size=3><FONT style="BACKGROUND-COLOR: #ffffff"><SPAN style="FONT-FAMILY: Dotum"><FONT color=#57048c><SPAN style="FONT-SIZE: 11pt"><FONT color=#2b8400><FONT color=#000000>7. 자기소개,현 질병상태와 치료경과 등 : </FONT></FONT></SPAN></FONT></SPAN></FONT></FONT> </P>
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