COURSE REGISTRATION / MEMBERSHIP APPLICATION FORM

COURSE TITLE: ________________________________________________________ COMMENCEMENT DATE: ______________________________________________ (1) PERSONAL PARTICULARS:

(Ms/Mdm/Mr) Name: ... NRIC No: . Mobile No: Tel (Home): . Email Address (if any): ... Date of Birth: Age: Nationality: Sex: M / F* Mailing Address (Home / Office)* : .. .. Singapore ( . ) Education Background (Please attach copies of certificates, where applicable): Name of Institution Certificate Awarded Year

SELF - SPONSOR COMPANY SPONSOR

(Please TICK in the appropriate box.)

(2) EMPLOYMENT / COMPANY DETAILS

Current Position: Office Tel No: .. Office Fax No: . No of years of experience in relation to above course: . Company: Company address: . Singapore ( . ) Company Email Address (if any): FOR COMPANY SPONSORSHIP ONLY: Officer-in-charge (Ms/Mdm/Mr): Designation: . Tel No: .. Fax No: .....
Note: For Corporate application, please refer to Corporate Membership Form.

(3) GENERAL INFORMATION

1. 2. All courses will be conducted in English unless otherwise stated. To qualify for the SDF subsidy, participants must:i) be sponsored by their company ii) have minimum of 75% attendance throughout the whole course and sit for the examination iii) be Singapore citizens or Permanent Residents Notice of withdrawal must be given in writing 60 days before course commencement date for full refund. There is no refund if notice is received more than 3 days after course commencement date. Payment must be made 2 weeks before course commences. SIMM reserves the right to defer/cancel any scheduled course due to unforeseen circumstances. If a course is deferred, fee will be refunded in full upon request. The Institute reserves the right to alter or amend the tuition and other related fees as it deems necessary. Membership annual subscription are payable in advance on admission and thereafter annually on the 1 st st st January each year but not later than 31 March each year. New members who joined after 1 July will pay half the subscription rate for the year. Confidentiality clause: All information given to SIMM will be kept strictly confidential and used solely for communication with the participants.

Attach Recent Passport Size Photo

3. 4. 5. 6. 7.

Fee before GST: Individual Membership Fee

Entrance Fee: S$50.00 Annual Subscription Fee: S$36.00 (January to December) S$18.00 (July to December)

8.

How did you find out about us? _______________________________________________________

Course Application Fee

For Certificate Courses: S$50.00 / S$100.00 (Bridging) For Diploma/ Adv or Grad Diploma: S$80.00

(4) PAYMENT
Enclosed herewith is a crossed cheque .. for the sum of SIN$ . made payable to SINGAPORE INSTITUTE OF MATERIALS MANAGEMENT

Membership No: . Membership Validity:

By signing on this form, I allow SIMM to use my photos for promotional publication. I confirm that the above information is true and correct to the best of my knowledge at the time of my membership application. If accepted, I understand to abide by the Constitution of the Institute and pay the relevant dues.

______________________________________________ Officer-in-charge Signatory & Company Stamp

______________________________________ Student or Member Signature

______________________ Date

FOR OFFICIAL USE ONLY:

Course Admission: Approval by Internal Examiner ______________________________________________________________________ Membership Acceptance: Approval by Board of Directors ________________________________________________________________
Please submit the application form duly completed to: Singapore Institute of Materials Management, 229 Mountbatten Road, #03-28 Mountbatten Square, Singapore 398007 Tel: (65) 6484 5737 Fax: (65) 6484 5537 Email: info@simm.org.sg Website: http://www.simm.org.sg (This form may be photocopied for additional participants) OM-PSU-0001-F001 12 Apr2010 Rev B