Course Registration Form

(refer to Course Schedule)
Company Sponsor

(1) PERSONAL PARTICULARS (All fields are mandatory)

Salutation*: Name*:
NRIC/FIN No.*: Mobile No.*: Tel (Home)*:
Email address*:
Date of Birth (dd/mm/yy): Age: Nationality:
Gender*: M / F

Home/Mailing Address:  Singapore ( )

Educational Background (enter the highest education level first)
(Please fax in photocopies of certificates & transcripts to avoid delay in processing)

Name of Institution Certificate Awarded Year

How did you find out about us?*

(2) EMPLOYMENT HISTORY (with most recent employment first)

Job Title*: No. years of experience:
Company Name*:
Office Tel No.: Office Fax No.:
Company Address:  Singapore ( )
Email Address:

For Company Sponsorship only
Officer-in-charge (Mr/Mdm/Ms) Designation:
Tel. No.: Fax No.:
Email Addresses:

(3) REGISTRATION - GENERAL INFORMATION (please read before submitting form)

Pursuant to The Personal Data Protection Act (PDPA) 2012 Singapore (which includes data protection rules which came into effect on 2 July 2014), I agree to receiving from SIMM email, text messages, phone calls, or fax messages containing notices, membership status update, accounts related information, course or trainer/trainee-related satisfaction surveys, market research, statistical analysis to better understand trainee profile, improve course offering, photographs, promotions and marketing materials. Additionally, I agree personal information collected relates to the practice of course enrolment and related process including and not limited to reference checks, comprehensive understanding, verification of skills, experiences, assessment of suitability for course enrolment and others.

In connection with the above, I have read, understand and agree to be bound by the above as amended from time to time. By submitting my data in this form, I represent and warrant that the information/details given in this application is complete, true and accurate. If accepted, I shall abide by the Constitution of SIMM and pay the relevant dues.

SIMM Contact:
Tel: 6653 1233 Fax: 6254 0704

For SIMM Official Use:

Course Admission: _________________________

Approved by Internal Examiner: ____________________

Date: _______________

Membership Fee for Individual:
Entrance Fee: S$50.00
Annual Subscription Fee:
S$36.00 [Jan to Dec]
S$18.00 [Jul to Dec]

Membership Number: ____________

Membership Validity: _____________