"*" indicates required fields Membership Application FormConsent I wish to apply to become a member of Pharmaceutical Society of Singapore (“Society”). I consent to sharing my personal data in this application with the Society for the purposes of membership maintenance, training and other administrative and communication purposes. Section BreakA) Membership Category: Pursuant to the Constitution,Type of membership Ordinary Members: All registered pharmacists and those eligible for registration under the Pharmacist Registration Act of the Republic of Singapore or such Acts and laws as may be enacted from time to time. Fee payable = $20 admin fee + $120 for full year or $20 admin fee + $60 for 1st July onwards. Associate Members: Pharmacy graduates who are not eligible for Ordinary Membership. (e.g. Pre-Registration Pharmacist). Fee payable = $20 admin fee + $60 for full year Overseas Members: Ordinary members of the Society who have become residents in other countries permanently or for a continuous period exceeding six months and are still interested in continuing their ties with the Society. On their return to reside in Singapore, they may apply for their membership to be reverted to Ordinary Membership. Fee payable = $20 admin fee + $60 for full year Student Members: Pharmacy undergraduates of the National University of Singapore and other Universities. Fee payable = $10 for full year All membership applications are subject to approval of the prevailing Council of the Society. For enquiries, please contact PSS Secretariat here The Society reserves the right not to refund fees wrongly paid. Official receipt for membership fees paid will be issued only upon request. Section BreakB) Personal Particulars:Prefix:– Please select –ProfA/ProfDrMrMrsMsMdmName: First PRN No.: NRIC/FIN: E.g., S-XXXX123-AYear of Birth:– Please select –2008200720062005200420032002200120001999199819971996199519941993199219911990198919881987198619851984198319821981198019791978197719761975197419731972197119701969196819671966196519641963196219611960195919581957195619551954195319521951195019491948194719461945194419431942194119401939193819371936193519341933193219311930Nationality – Please select –AfghanistanAlbaniaAlgeriaAmerican SamoaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAustraliaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelizeBeninBermudaBhutanBoliviaBonaire, Sint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBrunei DarussalamBulgariaBurkina FasoBurundiCabo VerdeCambodiaCameroonCanadaCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos IslandsColombiaComorosCongoCongo, Democratic Republic of theCook IslandsCosta RicaCroatiaCubaCuraçaoCyprusCzechiaCôte d'IvoireDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEswatiniEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuamGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHoly SeeHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqIrelandIsle of ManIsraelItalyJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKorea, Democratic People's Republic ofKorea, Republic ofKuwaitKyrgyzstanLao People's Democratic RepublicLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacaoMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth MacedoniaNorthern Mariana IslandsNorwayOmanPakistanPalauPalestine, State ofPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalPuerto RicoQatarRomaniaRussian FederationRwandaRéunionSaint BarthélemySaint Helena, Ascension and Tristan da CunhaSaint Kitts and NevisSaint LuciaSaint MartinSaint Pierre and MiquelonSaint Vincent and the GrenadinesSamoaSan MarinoSao Tome and PrincipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSingaporeSint MaartenSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia and the South Sandwich IslandsSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwedenSwitzerlandSyria Arab RepublicTaiwanTajikistanTanzania, the United Republic ofThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkmenistanTurks and Caicos IslandsTuvaluTürkiyeUS Minor Outlying IslandsUgandaUkraineUnited Arab EmiratesUnited KingdomUnited StatesUruguayUzbekistanVanuatuVenezuelaViet NamVirgin Islands, BritishVirgin Islands, U.S.Wallis and FutunaWestern SaharaYemenZambiaZimbabweÅland Islands Country Name of Company: Occupation/Designation: Email: Contact No.:Preferred mode of contact: Contact No. Email Sector of Practice: Academia Community Hospital Industry Others Please specify: Section BreakC) Professional/Educational Qualifications:Education Bachelor of Pharmacy, National University of Singapore Graduating Year:– Please select –20232022202120202019201820172016201520142013201220112010200920082007200620052004200320022001200019991998199719961995199419931992199119901989198819871986198519841983198219811980197919781977197619751974197319721971197019691968196719661965196419631962196119601959195819571956195519541953195219511950Professional/Educational Qualifications Year Qualifications Institution/Country Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Section BreakD) Other Professional Affiliation/Membership:Other Professional Affiliation/Membership Other Professional Affiliation/Membership Actions Edit Delete There are no Entries. Add Entry Maximum number of entries reached. Section BreakE) Recommendation/Endorsement by the Society’s Ordinary Members:Name: First Membership No.: Name: First Membership No. Section Breakdeclaration_constitution_of_the_society* I agree to abide by the Constitution of the Society.*Declaration_pharmacist_code_of_ethics* I shall also uphold the Pharmacist’s Code of Ethics and strive to improve the standards of professional conduct.*Declaration_information* I hereby declare that the information provided herein are true and accurate.*SignatureDate DD dash MM dash YYYY PhoneThis field is for validation purposes and should be left unchanged.
