Organisational Membership Renewal

*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.

Sector: *

Note: Only existing APHN sectors can hold organisational membership. If your sector is not found in the list above, please apply for individual membership.

E-mail *
We wish to renew our membership for *
If you are renewing for more than 3 years, please indicate the number of years here:
Our annual subscription is *
Name of Organisation *
Particulars of Signatory / Contact Person
Title *
Gender *
Name *
Profession *
Specialty *
Position / Designation in Organisation *

Mailing Address

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

Contact Numbers

Office no. *
Mobile no.
Fax no.
Skype name
Your organisation's website
Number of years providing palliative care, hospice and related services: *
Average number of patients seen per month (for medical-based services, e.g. inpatient unit, hospice home care service, outpatient clinic, etc.): *
Average number of clients served per month (for non-medical-based services, e.g. counselling, support groups, training and education, etc.): *
Please update the type of service(s) provided: *
Please specify other service(s) not listed above:
Are there any area(s) your organisation would 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:
We have read and understand the Objectives and Values* of the Asia Pacific Hospice Palliative Care Network and agree to support and uphold them. *
We agree to have our name and contact details included in the Members' Registry on the APHN website. *
We would like to have our organisation listed on the online Directory accessible to members of the public. (If "Yes", please provide full address and essential contact numbers). *

Payment Options

Please select one of these options for payment of the membership *
  • 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

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