Muslim Healthcare Professionals Association Membership Form

Thank you very much for your interest in joining this Association.

The objectives of the Association are as follows :

a) Providing a platform for Muslim healthcare professionals to address Islamic issues involved in healthcare and to promote health education and healthcare in Singapore, to Singaporeans in general and specifically to Muslims in Singapore.

b) To represent the Muslim healthcare professionals in Singapore.

c) To promote the understanding and the application of Islamic Principles in the field of Medicine.

d) To promote the exchange of medical information and technical data among members.

Kindly fill up the following membership form and we shall get back to you as soon as we can with payment instructions as well as approval to join us!

Name
Your answer
Date of birth
MM
/
DD
/
YYYY
Salutation
NRIC / FIN
Your answer
Gender
Status
Professional Practising License Number (Doctors MCR, DCR, practising license for Nurses etc, matriculation/student no for students)
Your answer
Current Office/Department/Hospital/Organization
Your answer
Office Address
Your answer
Office Telephone
Your answer
Office Fax
Your answer
Home Address
Your answer
Home Telephone
Your answer
Handphone Number
Your answer
Preferred Mailing Address
Email Address
Your answer
Professional Qualification (Year) (For students - targeted year of graduation)
Your answer
Institution / University / Polytechnic (Country)
Your answer
Further professional qualification and year qualified
Your answer
Field of speciality (eg Cardiology, Radiology, Public Health)
Your answer
Name of Affiliated Professional Register / Association (eg Singapore Medical Council, Singapore Nursing Board)
Your answer
No of years in practice
Your answer
Would you like us to contact you on our activities via email?
Required
Would you like to list your business in the MHPA Business Network?
Types of Membership & Subscription Amount
Please tick onto the appropriate check box
Required
What are your areas of interests? Please tick the appropriate checkbox
Kindly tick the box below
Required
Consent for the collection, use and disclosure of personal data
Required
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