Ordinary Associate Supplementary
* Salutation Please select Mr Mrs Mdm Ms Dr Prof Assoc. Prof or Others
* Full Name as in Passport
* Last / Sur Name
* Gender Please select female male
* Date of Birth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008
* Marital status Please select Single Married Divorced
* Country of origin Please select ------------- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Espana Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Iran Iraq Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Republic of Korea (South) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa (Independent) San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka St. Helena St. Pierre and Miquelon Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wales Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
* Nationality Please select Afghan Albanian Algerian American American Samoan Andorran Angolan Anguillan Antiguan Argentine Armenian Aruban Australian Austrian Azerbaijani Bahamian Bahraini Bangladeshi Barbadian Belarusian Belgian Belizean Beninese Bermudian Bhutanese Bolivian Bosnian Brazilian British British Virgin Islander Bruneian Bulgarian Burkinabe Burmese Burundian Cambodian Cameroonian Canadian Cape Verdean Caymanian Central African Chadian Channel Islander Chilean Chinese Christmas Islander Cocos Islander Colombian Comoran Congolese Cook Islander Costa Rican Croatian Cuban Czech Danish Djiboutian Dominican Dutch Dutch Antillean Ecuadorian Egyptian Equatorial Guinean Eritrean Estonian Ethiopian Falkland Island Faroese Fijian Fillipino Finnish French Gabonese Gambian Georgian German Ghanaian Gibraltar Greek Greenlandic Grenadian Guadeloupe Guamanian Guatemalan Channel Islander Guinean Guyanese Haitian Honduran Hungarian Icelandic Indian Indonesian Iranian Iraqi Irish Israeli Ivoirian Italian Jamaican Japanese Jordanian Kazakhstani Kenyan Korean Kuwaiti Kyrgyzstani Laotian Lebanese Liberian Libyan Liechtenstein Lithuanian Luxembourg Macedonian Malagasy Malawian Malaysian Maldivian Malian Maltese Manx Marshallese Martiniquais Mauritanian Mauritian Mahoran Mexican Moldovan Mongolian Montserratian Moroccan Mozambican Namibian Nauruan Nepalese New Caledonian New Zealander Nicaraguan Nigerien Nigerian Niuean Ni-Vanuatu Norfolk Islander(s) Norwegian Omani Pakistani Palauan Panamanian Papua New Guinean Paraguayan Peruvian Philippine Pitcairn Islander Polish Portuguese Puerto Rican Qatari Reunionese Romanian Russian Rwandan Saint Helenian Kittitian Korean Saint Lucian Salvadoran Samoan Sammarinese Sao Tomean Saudi Senegalese Serbian Seychellois Sierra Leonean Singaporean Slovak Slovenian Solomon Islander Somali South African Spanish Sri Lankan Sudanese Surinamese Swazi Swedish Swiss Syrian Taiwanese Tajikistani Tanzanian Thai Timorese Togolese Tokelauan Tongan Trinidadian Tunisian Turkish Turkmen Tuvaluan Ugandan Ukrainian Uruguayan Uzbekistani Venezuelan Vietnamese Virgin Islander Yemeni Zambian Zimbabwean
* Residential Status Employment Pass Permanent Residence Singaporean Student Pass Dependent Pass
* Employment pass type P1 P2 Q1 Q2
* Employment Pass Number
* Employment Pass Expiry Date 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
* NRIC Number
* PR Since January February March April May June July August September October November December 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
* Staying In Singapore Since 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010
* Passport Number
* Personal Email
* Local Home Phone Number
* Mobile Phone Number
* Address 1
* Address 2
* Country Singapore------------- Afghanistan Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua And Barbuda Argentina Armenia Aruba Australia Austria Azerbaijan Bahamas Bahrain Bangladesh Barbados Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegowina Botswana Bouvet Island Brazil British Indian Ocean Territory Brunei Darussalam Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Cayman Islands Central African Republic Chad Chile China Christmas Island Cocos (Keeling) Islands Colombia Comoros Congo Congo, the Democratic Republic of the Cook Islands Costa Rica Cote d'Ivoire Croatia Cuba Cyprus Czech Republic Denmark Djibouti Dominica Dominican Republic East Timor Ecuador Egypt El Salvador England Equatorial Guinea Eritrea Espana Estonia Ethiopia Falkland Islands Faroe Islands Fiji Finland France French Guiana French Polynesia French Southern Territories Gabon Gambia Georgia Germany Ghana Gibraltar Great Britain Greece Greenland Grenada Guadeloupe Guam Guatemala Guinea Guinea-Bissau Guyana Haiti Heard and Mc Donald Islands Honduras Hong Kong Hungary Iceland India Indonesia Ireland Israel Italy Iran Iraq Jamaica Japan Jordan Kazakhstan Kenya Kiribati Korea, Republic of Korea (South) Kuwait Kyrgyzstan Lao People's Democratic Republic Latvia Lebanon Lesotho Liberia Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Micronesia, Federated States of Moldova, Republic of Monaco Mongolia Montserrat Morocco Mozambique Myanmar Namibia Nauru Nepal Netherlands Netherlands Antilles New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island Northern Ireland Northern Mariana Islands Norway Oman Pakistan Palau Panama Papua New Guinea Paraguay Peru Philippines Pitcairn Poland Portugal Puerto Rico Qatar Reunion Romania Russia Rwanda Saint Kitts and Nevis Saint Lucia Saint Vincent and the Grenadines Samoa (Independent) San Marino Sao Tome and Principe Saudi Arabia Scotland Senegal Serbia and Montenegro Seychelles Sierra Leone Singapore Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea Spain Sri Lanka St. Helena St. Pierre and Miquelon Suriname Svalbard and Jan Mayen Islands Swaziland Sweden Switzerland Taiwan Tajikistan Tanzania Thailand Togo Tokelau Tonga Trinidad Trinidad and Tobago Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States United States Minor Outlying Islands Uruguay Uzbekistan Vanuatu Vatican City State (Holy See) Venezuela Viet Nam Virgin Islands (British) Virgin Islands (U.S.) Wales Wallis and Futuna Islands Western Sahara Yemen Zambia Zimbabwe
* Postal Code
* Preferred Mailing Address Office Home
* Company Name Please selectInstitute of Molecular and Cell Biology (IMCB) Institute of Bioengineering and Nanotechnology Genome Institute of Singapore Bioprocessing Technology Institute Bioinformatics Institute Data Storage Institute Institute for Infocomm Research (I2R) Institute of Chemical and Engineering Sciences Chemical Synthesis Laboratory @ Biopolis Institute of High Perfomance Computing (IHPC) Institue of Materials Research & Engineering Institute of Microelectronics Singapore Institute of Manufacturing Technology Centre for Molecular Medicine Institute of Medical Biology (IMB) Singapore Institute of Clinical Sciences (SICS) Singapore Bioimaging Consortium (SBIC) Singapore StemCell Consortium (SSCS) Biomedical Research Council (BMRC) Science and Engineering Research Council (SERC) Experimental Therapeutic Centre (ETC)National University of Singapore (NUS) Nanyang Technology University (NTU) SIM University (SIMU) Singapore Polytechnic (SP) Ngee Ann Polytechnic (NP) Temasek Polytechnic (TP) Nanyang Polytechnic (NYP) Republic Polytechnic (RP) Private Ltd. & Research Institutes Clinical R&D Laboratories in Hospitals Others
Company Address
* Office Phone Number
* Office Fax Number
* Company Email
* Job Title / Occupation
* Area of Specialisation
* Human Resource / Registrar Name
* Human Resource / Registrar Email Address
* University / Education Institution
Academic Qualification (field of study)
* Bachelor
Masters Degree
PhD Degree
* Highest Qualification
Do you own a vehicle? No Yes
* Please Select your Hobbies and Interest Fishing Jigsaw Puzzles Movies Music Photography Reading/Library Shooting/Archery Singing Stamp Collecting Travel
* Sports and Games Badminton Basketball Billiards Bowling Bridge Chess Darts Golfing Gym Jogging Sailing Scuba Diving Snooker Snorkel Soccer Swimming Table Tennis Tennis Volleyball Weiqi
Other activities that are not included in the list
How do you come to know about IRC?
Will You be interested in volunteer work for A*STAR activities? No Yes If Yes, please give details:
If you are applying Supplementary Membership for your spouse please provide the following details
Spouse Name
Primary Member Name Search for Researcher Name
Primary Membership No. Search for Membership No.
Relationship with Applicant Please select Husband Wife
Primary Member Company Name
Search Children's Particulars
Child 1
Full Name as in Passport
Passport No.
Date of Birth 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 January February March April May June July August September October November December 1950 1951 1952 1953 1954 1955 1956 1957 1958 1959 1960 1961 1962 1963 1964 1965 1966 1967 1968 1969 1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015
Gender female male
School
Child 2
Child 3
Child 4
Your photo file should not be larger than 256KB. Allowable file formats are gif and jpg.
* Member Photo
I, the applicant, hereby declare that the particulars in this application are correct. * I Agree I, the applicant, understand that I am personally liable for the payment of the membership dues and charges incurred by me, my child (if applicable) and my guests in the use of the club's leased facilities and including those leased from external parties. * I Agree I accept that in the event of non-existing of IRC, the membership/renewal fee will not be refunded. * I Agree I agree to comply to the constitution, bye-laws, rules and regulations of the Club and those of any external parties from which the Club leases facilities (To see the cons, bye-laws, rule and regulations listed at http://www.irc.org.sg/site/constitution). * I Agree I understand that my approved IRC membership would be revoked if the information provided above is found to be untrue. * I Agree