SMA Membership Application

Application Date

18/08/2017

Membership Type*

PERSONAL PARTICULARS

Salutation*

NRIC Type*

NRIC/Passport/FIN No.*

Name* (as in NRIC/Passport/FIN)

MCR No.* (Students please indicate matriculation number)

Nationality*

Date of Birth* (DD/MM/YYYY)

Race*

Religion*

Gender*

Marital Status*

Hobbies / Interests

How did you get to know about SMA?

Referral Name

Referral MCR No

Private Email(User ID)*

Password*

Confirm Password*

Preferred Mailing Address*

PRACTICE CONTACTS

Information entered here will be listed in our Online Directory of SMA Doctors if you enabled the option. Members of the public will be able to search for your practice and view all information provided under “Practice Contacts”.

Name of Clinic/Institution*

Address line 1*

Address line 2*

Address line 3*

Postal Code*

Country

Phone

Fax

Email

Website

Opening Hours

HOME CONTACTS

Address line 1*

Address line 2

Address line 3

Address line 4

Postal Code*

Country

Phone

Fax

PROFESSIONAL QUALIFICATIONS

Professional Qualification
(registerable with SMC)

Country of Graduation

Medical School/University

Year of Graduation

Area of Practice

Specialty 1*

Specialty 2*

Specialty 3*

Designation/Position Held

Rates

Graduated in Year 2010 or before	$107.00
Graduated in Year 2011 - 2013	$80.25
Graduated in Year 2014 - 2016	$53.50
Graduated in Year 2017	$26.75
Spouse Membership (Complimentary)	N.A
Overseas Membership	$75.00
Student Membership (Complimentary)	N.A

All membership fees are in Singapore Dollars and inclusive of 7% GST (except for Overseas Membership).
SMA Membership subscription is tax deductible.

In-Principal Approval of Website Accounts

Receipt of your application fee is not an indication of successful application. Those who have submitted the application form and payment will be granted in-principle approval of membership. You will be able to log in to the SMA portal and access exclusive members-only functions.

Please note that your membership application is still subject to approval of the SMA Council. We will inform you of your application status in due course.

Privacy Policy

Your personal data is collected for the administration of your SMA membership application. Information may be disclosed to third parties to facilitate the enjoyment of membership benefits provided to our members from time to time, such as for the purposes of the verification of membership validity, redemption or delivery of prize and gift, update of web-based membership portal, processing of payment for products and services purchased and other membership related matters.

Personal data is also collected for the dissemination of publications, news and events updates, and/or marketing campaigns in relation to the goods and/or services that we and/or our business partners provide, or on our behalf. You may unsubscribe from this service at any time.

		I, the undersigned, confirm that the facts and details provided are true and accurate to the best of my knowledge. As a member of SMA, I agree to be bound by the SMA Constitution at all times.


		I consent to the collection, usage and disclosure of my personal data.

	Include me in Online Directory of SMA Doctors
	Include me in SMA Email List
	I would like to receive a printed copy of the SMA News
	I would like to receive a printed copy of the SMJ

SMA CALENDAR