SFCS MEMBERSHIP APPLICATION FORM
Title Prof Dr Mr Ms Mrs
First Name Last Name
Profession/
Specialty
NRIC No Country
Address
Date of Birth (dd/mm/yyyy) Religion
Race Sex Male    Female
Nationality Marital Status
Occupation Telephone
Office Tel Pager
Mobile Number Email address
Membership Type:

Individual Member ($30/– entrance fee; $20/– annual subscription)
Corporate Member ($30/– entrance fee; $300/– annual subscription)
Life Member ($30/– entrance fee; $100/– one time payment)

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. In the following page, you will be able to print a copy of this completed form for your reference.

 THE HONORARY SECRETARY
SOCIETY FOR CONTINENCE (SINGAPORE)
Camden Medical Centre
1 Orchard Boulevard #04-03
Singapore 248649
Fax: (65) 6588 1723

  

 

 

 

 
 
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