AMBIS Application for Membership
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Designation *
Family Name/ Surname *
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Given Name *
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Date of Birth *
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Gender *
NRIC/Passport number *
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Nationality *
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Professional Qualifications
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Job title *
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Company or Institution *
where you work
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Corresponding Address *
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Email *
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Contact number *
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Areas of interests in healthcare informatics
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Declaration
By submitting this form, I hereby declare that the particulars given above are correct and if accepted as a member, I shall abide by the Constitution of AMBIS (Refer to www.ambis.org.sg for the Constitution).
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