New Application
PLEASE NOTE
In accordance to paragraph 7(1) in the Constitution, the proposal of candidates for membership for Ordinary Member, Associate Member, Absentee Member and Overseas Member:
“Application shall be made on the appropriate form by a person who must be proposed by a member of the Society. A member, elected by majority vote of the Council, shall be provided a copy of the Constitution of the Society and shall be eligible to participate in the Society’s activities upon the payment of the initial annual subscription. The Council may refuse membership if the Council considers that the practices or conduct of the applicant may be prejudicial to the interests of the Society or the reputation of the medical profession as a whole.”
Annual subscription for Ordinary Member, Associate Member and Overseas Member is S$50.00 .
To register, please fill in the form below, alternatively, you may
download this form here
and fax it to the secretariat Ms Michelle Choy at: (65) 6372 1793
First Name *
Family Name *
Gender *
Male
Female
NRIC / Passport No: *
Home Address
Office Address *
Date of Birth *
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Telephone No. *
Mobile No. *
Facsimilie No.
Email Address *
MCR No. *
(if applicable)
Professional Qualifications *
Position *
Proposer *
Seconder *
Application and subscription fee - S$50.00
Payment
Payment Method *
-- Select your payment method --
Cheque/Bankdraft
Credit Card
Credit Card
Credit Card *
American Express
MasterCard
VISA
-- please select --
Card No. *
Name on Card *
Expiry Date *
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January
February
March
April
May
June
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August
September
October
November
December
/
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2012
2013
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2015
2016
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2019
2020
Security Code (CVV) *
CityState conference & exhibition Pte Ltd, is authorized to act on behalf of SCCPS.
All credit card charges will be made by the merchant name: Citystate Travel Pte Ltd.
By Cheque/ Bankdraft
Make payable to "SCCPS"