APPLICATION FORM FOR DISTINCTIONS

Name
Chinese Name (If applicable)
PSS Membership No. / /
Address
Email
Contact (HP) (H) (O)
Application ee! "PSS S#$%.%%
APSS S#&%.%%
PSS S#'%.%%
I understand that once my application of the Distinctions of The Photoraphic Society of
Sinapore had !een successful" I shall !e entitled to use the title of L#P#S#S or A#P#S#S or F#P#S#S
after my name as lon as I am a mem!er of the Society#
I here!y declare that the a!o$e information is correct and complete# If the process is delayed or
not effected for reasons of incomplete information" I %ould not hold the Society responsi!le#
FOR OFFIC& 'S&
(ate )ecei*ed Amo+nt Paid
Mode of Pa,ment Cash / -ISA / Master / AME. / Che/+e
Che/+e No. / Credit Card )ef No.
)eceipt No.!
Si0nat+re of Collector (ate
Si0nat+re of Applicant / (ate
Payment can !e made to PSS (an) Account* D(S ++, +-. ,../
Passport Photo
(Optional)