ICAAS
Imperial College Alumni Association of Singapore 

Membership Subscription and Information Form. 
Name (Prof/Dr/Mr/Mrs/Ms):		
Email:		
Mailing Addr (home/Office):		
Years at Imperial College: 	From:                                 To:	
Department: 		
HOME		
Home Addr: 	

Home Tel: 		
Home Fax: 		
OFFICE		
Office Addr: 	

Office Tel: 		
Office Fax: 		
Please tick below the type of membership that you would like to subscribe to: 
Ordinary Membership	$36 per annum	
Life Membership	$300 one-time payment	
For currently enrolled Imperial College students, an associate membership is offered: 		
Associate Membership	Free for currently enrolled Imperial College students. Also comes with one-year free Alumni membership upon graduation/or Life membership at offer of $270 upon graduation.	

Do not send cash. Please make cheque payable to: Imperial College Alumni Association of Singapore.  Send to: 
Prof Wong Limsoon 
Imperial College Alumni Association of Singapore
c/o Institute for Infocomm Research 
21 Heng Mui Keng Terrace
Singapore 119613