purchase

							                                                                         SINGAPORE MEDICAL ASSOCIATION
                                                                         2 College Road, Level 2, Alumni Medical Centre, Singapore 169850
                                                                         Tel: 6223 1264 Fax: 6224 7827 Email: sma@sma.org.sg
                                                                         Website: www.sma.org.sg
Purchase of SMA Products
Full Name: Dr _______________________________________ MCR: _________________                              Payment by Credit Card:
Contact numbers (handphone / office): ________________________________________                            Card Number: ______ - _______ - _______ - ______
Address to mail item(s) to: ___________________________________________________                           Expiry Date (mm/yy): _____ / _____
___________________________________________________________________________                               CW2/CVC2 No. : ______ (This is the last 3 numbers
                                                                                                          behind the credit card)


                                                                             Unit Price (S$), includes 7% GST      Postage/ Handling (S$)
S/N     Item Description                                                    SMA Member            Non-Member                    (per item)    Quantity      Amount (S$)
1       Guideline on Fees Book - 4th Edition (2006) (Withdrawn)                Withdrawn             Withdrawn                         1.00
2       Display of Charges Tent Card                                                 10.70                 26.75                       1.00
3       Ethical Code Book (No Stock)                                                 10.70                 10.70                       1.00
4       Private Practice Handbook (No Stock)                                         12.85                 21.40                       1.00
5       The Medical Profession & Pharmaceuticals (No Stock)                          10.70                 10.70                       1.00
6       Fitness to Drive Book                                                        10.70                 10.70                       1.00
7       SMA Doctors' Directory 2006/2007                                             25.00                 50.00                       8.00
8a      Medical Malpractice in Spore (Author: SY Tan) in Softback          Free (1st Copy)                 23.00        Collection at SMA
8b      Medical Malpractice in Spore (Author: SY Tan) in Hardback                    46.00                 46.00        Collection at SMA
9       Locum Registration                                                            Free 16.05 (per month)                           1.00
10      Request for Locum List                                                        Free      16.05 (per copy)                       1.00
11      A&E Referral Forms                                                            5.35                  8.60              1 pad - 1.50
                                                                                                                             2 pads - 3.00
                                                                                                                           3-5 pads - 4.00
                                                                                                                          6-8 pads - 10.00
                                                                                                                         9-10 pads - 12.00
12      SMA Tie                                                                      16.05                21.40         Collection at SMA
13      SMA Scarf (No Stock)                                                         21.40                26.75         Collection at SMA
14      SMA Car Decal (new)                                                           2.00          Not for Sale                       0.50
15      SMA Sticker                                                                   1.00          Not for Sale                       0.50
16      SMA Tshirts (Colours available : Orange & Olive Green)                       20.00                20.00                        1.00

Notes
1) Please fill up the above table, stating clearly the quantity requested, the sub-total amount, and the grand-total amount.
2) If you are paying by cheque, please enclose a cheque made payable to the "Singapore Medical Association". Mail form and cheque to SMA (address above).
3) The item(s) requested will be mailed to you upon receipt of payment. An official receipt will be issued to you.
4) For items marked "(No Stock)", a photocopy version is available at half price. Postage/ handling fees still apply.