MEMBERSHIP FORM Full name(Required) Full name Salutation(Required)ProfessorAssociate ProfessorDrMrMsMdmSex(Required) Female Male Marital Status(Required) Date of Birth(Required) MM slash DD slash YYYY MCR/SNB/Reg No(Required) Department(Required) Designation(Required) Institution(Required) Mailing Address(Required) Contact No(Required) Email(Required) APPLICANT’S DECLARATIONI would like to apply/renew* the membership with Healthcare Quality Society of Singapore and enclose payment of(Required) Bank : Cheque no: for the Year of : Signature(Required) Date(Required) MM slash DD slash YYYY MEMBERSHIP INFORMATION Ordinary Members ($25/year) Associate Members ($25/year) Term of Membership Ordinary Members: Price: Are practising healthcare quality professionals or any person interested/involved in healthcare quality and must be Singapore Citizens or Singapore Permanent ResidentsOverseas/Outstation Members and House Officers: Price: Shall be Non-Residents and shall have neither the right to vote nor the right to hold office in the Society.Term of Membership Price: All application is for 1 year membership only and renewable each year.Total Mode of Payment(Required)PayNowBank TransferCheque PaymentUEN Number: T07SS0104GAccount Name: Healthcare Quality Society of Singapore Bank Account Number: 008-901123-5 Beneficiary Bank: DBS Bank Account Type: Current Account Cheque to be made payable to “Healthcare Quality Society of Singapore” and mailed to the secretariat: Wizlink Consulting Pte Ltd 2, Venture Drive, #06-25, Vision Exchange, Singapore 608526 Attn: HQSS Secretariat Please send the screenshot of the transaction slip to our secretariat at secretariat@hqss.org. CAPTCHA
