SPS PERSONAL PARTICULARS – Wizlink Consulting Pte Ltd

PERSONAL PARTICULARS

Surname(Required)

Name(Required)

Title(Required)

Sex(Required)

Female

Male

Nric No:(Required)

MCR No (For Singaporean Doctors)

Date of Birth(Required)

Name of Clinic / Institution:(Required)

Practice Address(Required)

Office Tel(Required)

Fax

Email(Required)

Specialty / Subspecialty interest (if applicable):

Home Address(Required)

Home Contact Tel(Required)

HP(Required)

Membership subscription fees is valid for 1 year (Jan – Dec)

Ordinary Members: $50.00

Overseas/Outstation Members and House Officers: $25.00

Associate Members: $12.00

Ordinary Members:

Price:

Overseas/Outstation Members and House Officers:

Price:

Associate Members:

Price:

Total

Mode of Payment(Required)

Cheque or bank draft, in Singapore Dollars, should be crossed and made payable to “Singapore Paediatric Society” and mail it to the following address:
Wizlink Consulting Pte Ltd 2, Venture Drive #06-25, Vision Exchange
Singapore 608526
Attn: SPS Secretariat
Kindly email a copy of the transaction slip to secretariat@sps.org.sg for verification purpose.

Transfer the payment with bank details as follows:
Bank Account Name: Singapore Paediatric Society
Bank Account Number: 067-000421-3
Name of Beneficiary Bank: DBS
Address of Bank: 12 Marina Boulevard, Level 3
Marina Bay Financial Centre Tower 3, Singapore 018982
Swift Code: DBSSSGSG
Kindly email a copy of the transaction slip to secretariat@sps.org.sg for verification purpose

Membership subscription: (Year)(Required)

As a member of SPS, I agree to abide by the Society’s Rules and Constitution at all times.(Required)

As a member of SPS, I agree to abide by the Society’s Rules and Constitution at all times.

Date of Application/Renewal(Required)

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