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Application form for membership

SECTION A - Personal Particulars

Note: Photo size 35 mm by 45 mm with white background, jpeg format

Gender:


** SECTION B – Academic / Professional Qualifications
Academic/Professional Qualifications Institution Year
** SECTION C – Accreditation By / Membership of Mediation Institution
Name of Institution / Organization Year Details of Accreditation / Training
** SECTION D – Membership with other Societies or Organization relating to Mediation
** SECTION E – Membership Subscription Fees   Rates
** Administration/Processing Fees - $100.00
*All applicants must pay the processing fees of $100 with the membership subscription fees except for student membership.
** SECTION F - Declaration
I declare that the above information is correct and true to the best of my knowledge and belief.

By signing this application form, I agree that International Institute of Mediators (Singapore) Ltd (iim) may for the administration of membership with iim, for the provision of services and/or activities to iim’s Members, which are in furtherance of the objects set out in the forms and conditions of memberships, collect, use and disclose my personal data, as provided in this application form and/or as provided to iim during or after this application and/or membership to iim, in accordance with the Personal Data Protection Act

I confirm that I have read and agree to be bound by the Constitution / By-laws / any terms and conditions of membership with iim, copies of which are available at iim’s registered address, during normal working hours.