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 of the Asia Pacific Hospice Palliative Care Network. Please click here to read the Objectives.

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* 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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