Gastroenterological Society of Singapore
MEMBERSHIP APPLICATION / RENEWAL FORM
APPLICANT’S INFORMATION
Salutation
Mdm
:
Full Name:
:
Prof.
A/Prof.
Dr.
Mr.
Ms
(Kindly print your Family/Last Name in CAPTIAL )
(As in NRIC/PP)
NRIC/PP No
:
Designation
:
MCR\Reg No.:
Division/Department :
Institution
:
Office Address
:
Home Address
:
Mailing Address
:
Contact No
:
Email
:
Office Address
Home Address
(Office)
(Mobile)
APPLICANT’S DECLARATION
I would like to apply/renew* the Ordinary/Associate* membership with
Gastroenterological Society of Singapore and enclose payment of $20/$5* for the Year____.
(Bank:
Cheque no:
Signature
)
Date
Membership Information
Payment Notes
Ordinary Members ($20/year) shall be medical practitioners who hold a
registrable qualification in Singapore and who are practicing Gastroenterology
and/or Hepatology or are interested in Gastroenterology and/or Hepatology.
Associate Members ($5/year) shall be healthcare/scientific workers other than
medical practitioners engaged in fields related to Gastroenterology and/or
Hepatology or medical practitioners who do not qualify as an Ordinary Members.
Term of Membership
All application is for 1 year membership only and renewable each year.
Please return the completed
application
form
to
GESS
Secretariat, together with your
cheque payment, made payable to
Gastroenterological Society of
Singapore. You will receive an
official receipt from the Secretariat
within 10 working days.
c/o Wizlink Consulting Pte Ltd
12 West Coast Walk, #02-06, West Coast Recreation Centre, Singapore 127157
Tel: (+65) 6774 5201 • Fax: (+65) 6774 5203 • Email: secretariat@gastro.org.sg
Rev 2013