SingSPEN Membership Application Form – SingSPEN – Society for Parenteral and Enteral Nutrition (Singapore)

APPLICANT'S INFORMATION

Salutation*

Full Name (As in NRIC/PP)*

MCR/Reg No

Designation*

Department

Institution/Clinic*

Mailing Address*

Street Address Street Address Line 2 Postal / Zip Code Country

Mobile No.*

Office No.

E-mail*

APPLICANT’S DECLARATION

Ordinary Members shall be any person who are practicing Clinical Nutrition. Membership subscription is for 1 year only and is renewable within the first month of the financial year. The annual subscriptions fee shall be determined at the General Meeting, on recommendation from the Executive Committee from time to time. Currently, the annual subscription fee is at SGD 30/year*

I hereby apply to join the Society for Parenteral and Enteral Nutrition (Singapore) as an ordinary member and agree to abide by the rules and regulations of the Society.

As member of SingSPEN, you are also eligible to join ESPEN at a discounted rate of SGD 125+ through SingSPEN Block Membership or SGD 48+ (as Junior or Senior member). To find out more about the ESPEN membership benefits visit http://www.espen.org/members/join-espen.*

No, I do not wish to join ESPEN

Yes, I wish to join ESPEN as an Individual Member (@ SGD 125/year)

Yes, I wish to join ESPEN as a Junior Member and declare that I am under the age of 32 years (@ SGD 48/year)

Yes, I wish to join ESPEN as a Senior Member and declare that I am over the age of 65 years (@ SGD 48/yearl

You have applied to be an ordinary member of SingSPEN. Your total membership subscription fee will be SGD 30 and you will be making payment by:*

Cheque

Bank Transfer

You have applied to be an ordinary member of SingSPEN and Individual Member of ESPEN. Your total membership subscription fee will be SGD 155 and you will be making payment by:*

Cheque

Bank Transfer

You have applied to be an ordinary member of SingSPEN and Junior Member of ESPEN. Your total membership subscription fee will be SGD 78 and you will be making payment by:*

Cheque

Bank Transfer

You have applied to be an ordinary member of SingSPEN and Senior member of ESPEN. Your total membership subscription fee will be SGD 78 and you will be making payment by:*

Cheque

Bank Transfer

PAYMENT INSTRUCTION

Cheque Payment - Cheque , in Singapore Dollars, should be crossed and made payable to “SingSPEN”. Kindly write your name on the reverse side of the Cheque and mail it to our secretariat.

APPLICATION NOTES

Your application will only be confirmed upon receiving your payment. An official receipt will be sent to you within 10 working days upon receiving your payment.

PAYMENT INSTRUCTION

Bank Transfer - Please transfer your subscription fees to the account as below, indicating your name in your transaction for identification purposes. Kindly send the transaction slip to secretariat@singspen.org.sg.

Account Name: SingSPEN
Account No: 451-303-010-4
Bank Name: UOB

APPLICATION NOTES

Your application will only be confirmed upon receiving your payment. An official receipt will be sent to you within 10 working days upon receiving your payment.

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