Organizational Membership Renewal Part 1 of 2

This form is ONLY for ONLINE PAYMENT by CREDIT / DEBIT CARDS.

*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.

Please note:
If you will like to pay by BANK DRAFT or CHEQUE, please fill in your renewal form HERE.

E-mail *
Name of Organisation *
Particulars of Signatory / Contact Person
Title *
Gender *
Name *
Profession *
Specialty *
Department
Position / Designation in Organisation *

Contact Numbers

Office no. *
Fax no.
Skype name
Your organisation's website
Please update the type of service(s) provided: *
Please specify other service(s) not listed 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 Booklet given to all APHN members. *
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). *
Please enter the words in the box to confirm your renewal:

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

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