SOHNSS :: Membership

MEMBERSHIP FORM
(For Specialists registered in Singapore Only)

1. TYPE OF MEMBERSHIP

* Indicates required field

Categories *

Full Membership (SGD 30.00) Associate Membership (Complimentary)

Full membership:
For O-HNS Specialists who are registered with the Singapore Medical Council.

Associate Membership:
For registered Medical Practitioners and to persons who are not medically qualified, but whose occupation or interest is concerned with the art and science of Otolaryngology.

2. PERSONAL PARTICULARS

Titles *

First/Given Name *

Last/Family Name *

Date of Birth *

MCR No *

Residential Address *

Line 1

Line 2

City

State

Zip Code

Country

Gender *

Nationality / Citizenship *

Preferred Email *

Contact Number *

3. PLACE OF WORK

Institution / Organisation *

Designation / Job Title *

Address *

Line 1

Line 2

City

State

Zip Code

Country

Department (if any) *

Work Email *

Work Phone (if different from above) *

4. EDUCATION QUALIFICATIONS (in chronological order)

a. Qualification Attained *

Year Attended / Completed *

Institution & Country *

Course / Major (s) *

b. Qualification Attained *