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[null,"北 京 任 月 林 脑 病 医 学 研 究 院                 任氏神经触激术学术委员会申请表"]
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[{"$nulls":7},"年","月","日"]
[null,"姓名 ",null,"性别",null,"年龄",null,"民族",null,"照片"]
[null,"籍贯",null,"职务",null,"职称",null,"QQ"]
[null,"邮编",null,"邮箱",null,null,"微信"]
[null,"工作单位",{"$nulls":4},"联系电话"]
[null,"身份证号",{"$nulls":4},"执业证号"]
[null,"详细通讯地址"]
[null,"申请职位：",null,null,"1、主任委员  2、副主任委员  3、常务委员  4、委员           5、秘书长    6、副秘书长"]
[null,"推荐概述："]
[null,"参加培训履历："]
[null,"学术成果："]
[null,"获奖情况："]
[null,"基地主任审批意见："]
[null,"办公室主任审批意见："]
[null,"秘书长审批意见："]
[null,"学术委员会审查意见：（盖章）"]

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