APFA Membership Application Form

Membership Application Form

APFA ASIA PRE-HOSPITAL & FIRE RESCUE

FEDERATION ASSOCIATION

Correspondence Address: 52 Bt Batok East Ave 5 # 26-05 Singapore 659802

Training Centre: 1 Coleman Street #08-10 The Adelphi, Singapore 179803

Tel: (65)63335292 Fax: (65)63390480 Website:http://www.emergencies.com.sg

PHOTO

TYPE OF MEMBERSHIP

CORPORATE MEMBER		S$350.00 per year
INDIVIDUAL MEMBER		S$100.00 per year	Membership No	______

Name (Mr/Miss/Mrs) English:

Name Thai :

Name Malay :

Identification No.

Date of Birth :

Organization English :

Position :

Sex :

Male Female

Company Tel :

Fax No. :

Business Address :

Portable/Pager :

Home Tel. :

E-mail Address :

Website :

Mailing Address :

Education Level :

Signature :

Date :

PROFESSIONAL CERTIFICATE / FIRST AID CERTIFICATE (Please supply copies of evidence)

VALID PERIOD	ORGANIZATION	QUALIFICATION OBTAINED

RAYAMARS CONSULTANT &

SERVICES SDN BHD

RCS Malaysia

EMERGENCIES FIRST AID

AND RESCUE

EFAR Singapore

FIRE AND RESCUE

ASSOCIATION

FARA Thailand

Application Procedure:

Please send the completed Application Form and enclose with the membership fee in a cheque made payable to ”Emergency First Aid & Rescue” to the address below:

Enquiry :

Head Quater APFA (EMERGENCIES FIRST AID & RESCUE)

52 Bt Batok East Ave 5 # 26-05 Singapore 659802

Tel: (65)6333 5292 Fax: (65) 6339 0480 Website: http://www.emergencies.com.sg

For Office use only:

Ref. No :

Payment Date:

Payment Method:

Receipt No:

Remark: