MEMBERSHIP APPLICATION FORM

Personal Particulars

Full Name as in Passport/Identity Card (underline Family Name):
Prof / Dr / Mr / Mrs / Ms*

Male

Female

Home / Postal Address:

Singapore Citizen

NRIC No.:

Foreign Citizen

Passport No.:

Telephone No.(Home):

Telephone No.(Office):

Mobile Telephone No.:

E-mail address:

Mailing Address (if different from above):

Category of Membership‡

Ordinary

Associate

Fees

Entrance Fee(one time payment)

$100

Payment by:

Annual subscription Fee

$100

Cash#

Please pay

$200

Cheque/money order

Details of cheque/money order:

Signature of Applicant:

Date:

For Office Use Only

Date Received:

Amount Received:

Date Approved by Committee:

Name of Approving Officer:

Signature of Approving Officer:

Notes:

* Delete as appropriate

# Do not send cash by post

‡ See Constitution for eligibility criteria