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Membership Renewal Form

First Name
Last Name
Home Address
Office Address
Telephone (home)
Telephone (office)
E-mail
Membership No

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Payment Details
Payment:	Cheque American Express MasterCard Visa

Amount
Cardholder Name
Card Number
Expiration Date
Cheque Number

Cheques should be made to Singapore National Institute of Chemistry
Supporting documents and payment, should be sent to:

SNIC Secretariat
c/o CMA International Consultants Pte Ltd
1 Liang Seah St
#02-12 Liang Seah Place
Singapore 189022

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