Individual Membership Renewal – Offline

*The APHN Constitution requires all members to agree and uphold the Objectives and Values of the Asia Pacific Hospice Palliative Care Network.
Please click here to read the Objectives and Values.

E-mail *
I wish to renew my membership for *
If you are renewing for more than 3 years, please indicate the number of years here:
My annual subscription fee is *
Name *
Title *
Gender *
Profession *
Specialty *
Which organization do you work for? *
Current Position/Title in work place *
Number of years working in palliative care: *
Proportion of your working time devoted to palliative/hospice care: *
Are there any area(s) you will like to contribute as a member? Please choose one or more of the following: *
Please specify other area(s) of contribution that is not mentioned above:
If you have selected teach/train on short-term basis, please indicate here the topics/subjects you are strong at:

Mailing Address

Name of Organisation/Company
Department
House / Block No.
Unit No.
Street / Road Name
City *
State / Province
Postal Code / Zip Code
Country *

Contact Numbers

Mobile no. (if you do not hold a mobile phone, please provide a contactable number): *
Office no.
Fax no.
Residential no.
Skype name
I have read and understand the Objectives and Values* of the Asia Pacific Hospice Palliative Care Network and agree to support and uphold them. *
I agree to have my name and contact details included in the Members' Registry on the APHN website. *

Payment Options

Please select one of these options for payment of your membership fee: *
  • If you are paying by bank draft, please ask your bank to convert from US dollars to Singapore dollars before buying the draft.
  • Please make bank draft or cheque payable to "Asia Pacific Hospice Palliative Care Network".

Please note:
After you have submitted the completed form, you will receive an email with the information you have submitted as a confirmation that your form was submitted successfully. If you have selected payment through PayPal, you will receive an email from the Secretariat providing the link to pay through PayPal within the next 10 working days.

The email reply will take around 10 working days.

If you require further assistance, please contact the Secretariat at membership@aphn.org.

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