On-line Membership Form
Title:
First Name:
Last Name:
Profession/Specialty:
NRIC No:
Country:
Address:
Date of Birth (dd/mm/yyyy):
Religion:
Race:
Gender:
Nationality:
Marital Status:
Occupation:
Telephone:
Office Tel:
Pager:
Mobile Number:
Email Address:
Membership Type:

  Please Note
  1. Individual membership shall be opened to all persons from healthcare professionals and individuals including patients suffering from incontinence.

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

  3. Life Membership shall be opened to all persons.

  4. Payment for membership should be made by teletransfer. 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)

     #07-03, 16 Kallang Place
     Singapore 339156