EMBALMERS ASSOCIATION SINGAPORE - ONLINE APPLICATION FOR MEMBERSHIP
CONSENT & ACKNOWLEDGEMENT
1. By completing this form, you hereby consent that the EMBALMERS ASSOCIATION SINGAPORE (EAS) in accordance with Personal Data Protection Act 2012, may collect, use, disclose and/or process your personal data so as to process, administer and/or manage your relationship with us as a member of EAS. Your personal data privacy is important to us and we are committed to safeguarding your personal data that we may possess. If you wish to withdraw your consent, kindly email
membership@eas.org.sg
2. I certify that the statements contained are true. I agree that in the event of my admission to any category of membership, I will be governed by the Constitution of Embalmers Association Singapore.
3. I will also submit the following documents via a separate email to
membership@eas.org.sg
:
a) A copy of my ID/Passport
b) Copies of relevant educational / training transcripts
c) Copies of relevant testimonials (if any)
d) Any other relevant documents that are able to support my application as a member.
4. The outcome of this Application of Membership will be made known to me within 5 working days from the day I submit this online form where instructions on the payment mode of my application for membership will also be emailed to me.
5. I will adhere to the Constitution of EAS if I am accepted as a member.
* Required
Email address
*
Your email
1. CATEGORY OF MEMBERSHIP
*
Practicing Membership
Associate Membership
Student Membership
Required
2. PERSONAL PARTICULARS
Full Name: Dr / Mr / Mdm / Mrs / Ms
*
Your answer
Gender
*
Female
Male
Country of Birth (e.g., Singapore)
*
Your answer
Citizenship (e.g., Singaporean)
*
Your answer
NRIC / FIN No
*
Your answer
Date of Birth
*
MM
/
DD
/
YYYY
Marital Status
*
Single
Married
Divorced
Separated
Other:
Race (e.g., Chinese, Malay, Indian etc)
*
Your answer
Religion (e.g., Christianity, Islam, Buddhist etc.)
*
Your answer
Home Address
*
Your answer
Postal Code
*
Your answer
Home Telephone Number
*
Your answer
Handphone Number
*
Your answer
Email
*
Your answer
3. EDUCATIONAL LEVEL
Highest Educational Level achieved / Year Completed
*
Your answer
State Embalming related course / qualification (s) e.g., Diploma in Embalming (if any) / Name of School / Year Graduated
*
Your answer
Other Qualification(s)
*
Your answer
4. EMPLOYMENT STATUS
Present Employment Status
*
Employed
Self-Employed
Other:
Required
Designation / Position in Company (e.g., Manager, Director etc.)
*
Your answer
Name of Company / Employer
*
Your answer
Address of Company / Employer
*
Your answer
Postal Code
*
Your answer
Office Phone No
*
Your answer
5. MEMBERSHIP IN OTHER ASSOCIATION(S)
Please state Membership and Position in other Associations (if any):
Name of Association / Year Joined / Position
*
Your answer
Name of Association / Year Joined / Position
*
Your answer
Name of Association / Year Joined / Position
*
Your answer
6. DESCRIPTION OF MEMBERSHIP AND MEMBERSHIP FEES
Choose only ONE (1) of the Membership Categories listed below i.e., Practicing Membership, Associate Membership OR Student Membership.
A one-time entrance fee of SGD$20.00 applies to all categories EXCEPT for the Student Membership Category.
PRACTICING MEMBERSHIP
1 YEAR (SGD$300.00)
2 YEARS (SGD$280.00)
3 YEARS (SGD$250.00)
Clear selection
ASSOCIATE MEMBERSHIP
1 YEAR (SGD$250.00)
2 YEARS (SGD$220.00)
3 YEARS (SGD$200.00)
Clear selection
STUDENT MEMBERSHIP
1 YEAR (SGD$80.00)
2 YEARS (SGD$50.00)
3 YEARS (SGD$30.00)
Clear selection
7. DECLARATION
Kindly tick the appropriate box below.
Do you have any existing medical condition, physical impairment or substance dependence?
*
Yes
No
Do you have any existing criminal records in Singapore or in any other country?
*
Yes
No
Have you ever been charged with any offence in a court of law in Singapore or in any other country for which the outcome is still pending?
*
Yes
No
Are you currently under police investigation in Singapore or in any other country?
*
Yes
No
Are you an undischarged bankrupt or do you have any outstanding unsecured debts?
*
Yes
No
I acknowledge that all information stated in this online membership application form is truthful to the best of my knowledge.
*
Yes
Thank you for your interest in becoming a member of EAS. We will get back to you on the outcome of your application via email within 5 working days.
SECRETARIAT, EMBALMERS ASSOCIATION SINGAPORE.
A copy of your responses will be emailed to the address you provided.
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