On-line Membership Form
Title:
First Name:
Last Name:
Profession/Specialty:
City/State:
Country:
Address:
Postal Code:
Telephone:
Fax:
Email Address:
Membership Type:

Please Note
  1. Individual and Life Memberships are opened to medical professionals.

  2. Corporate Membership is opened to all commercial bodies, firms, government departments,
    clubs or any organisation interested in supporting the Society in furthering its aims.

  3. Payment for membership should be made by Telegraphic Transfer. Information as follows:
    Bank name           : DBS Bank
    Account name     : Society for Continence (Singapore)
    Account number : 015-015744-5
    Bank address      : 301 Upper Thomson Road, Singapore 574408

  You shall hear from us on your membership status within 14 days after forwading your membership fee. You are
  adviced to print a copy of this form, for record purposes, BEFORE you click the submit button.


     THE HONORARY SECRETARY
      SOCIETY FOR CONTINENCE (SINGAPORE)

      16 Kallang Place #07-03
      Singapore 339156