Application for Individual Membership

*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.

Email *
I wish to apply for membership and would like to pay subscription for *
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 *
Name of Supporter (Must be APHN member) *
Email of Supporter (Must be APHN member) *
How did you come to know about APHN? *
Proportion of your working time devoted to palliative/hospice care *
What do you hope to gain as a member? *
Are there any area(s) you will like to contribute as a member? Please choose one or more of the following: *
Please indicate here the topic(s) or subject(s) you are strong at teaching/training. Or other area(s) you would like to contribute:
Mailing Address
Name of Organisation
House / Block No.
Unit No.
Street or Road Name
City *
State / Province
Post Code / Zip Code
Country *

Contact Numbers

Mobile no. *
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 email included in the Members' Registry Booklet given to all APHN members. *

Payment Options

Please select one of these options for payment of the subscription 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 after your membership application is approved. 

The email reply will take around 14 working days.

The application for membership of the Association shall be made in writing and shall be considered by the Council which shall have the absolute discretion to decide upon acceptance or rejection. No reason will be given for its decision, which shall be final and not be questioned in any court of law. (Constitution, article 6.2). More on membership rights, privileges and others, please refer to the APHN Constitution articles 6 to 9.

If you encounter any problems with the form, please contact us at

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