Title (required) ProfDrMrMsMrs
First Name (required)
Last Name (required)
Date of Birth (dd/mm/yyyy) (required)
Gender (required) —Please choose an option—MaleFemale
Nationality (required)
Mobile Number (required)
Marital Status —Please choose an option—SingleMarried
Home Address
Email Address (required)
Highest Education Level
Name of Employer/ Company
Occupation (required) —Please choose an option—Healthcare (Doctor/Nurse/Physiotherapist/Pharmacist/Others)Non-healthcare
Specialty (required)
Address of Hospital/Company
Office Tel (required)
Membership Type (required) —Please choose an option—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: 12 Marina Boulevard, DBS Asia Central, Marina Bay Financial Centre Tower 3, Singapore 01898
You shall hear from us on your membership status within 14 days after forwarding your membership fee. You are adviced to print a copy of this form, for record purposes, BEFORE you click the submit button.
Secretariat Branch: SOCIETY FOR CONTINENCE (SINGAPORE) 61 Upper Paya Lebar Road, #05-02A Singapore 534816
