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H.O.P.E. ALLIANCE MEMBERSHIP FORM 2020
Registration & Renewal of Membership
New Member: $40 a year
Membership Renewal: $20 a year
* Indicates required question
Date of Registration/Renewal of Memership:
*
MM
/
DD
/
YYYY
Name of Existing Member/New Member:
*
Your answer
Status of Membership:
*
Existing member
New member
Required
Gender:
*
Male
Female
Other:
Required
Age:
*
Your answer
Date of Birth:
*
MM
/
DD
/
YYYY
Race:
*
Chinese
Malay
Indian
Eurasian
Other:
Required
Marital Status
*
Single
Married
Divorced
Widowed
Other:
Required
Religion:
*
Buddhism
Taoism
Islam
Christianity
Hinduism
Free Thinker
Other:
Required
Highest Educaion Level
*
PSLE
GCE 'N' Level
GCE 'O' Level
GCE 'A' Level
NTC
Poly Diploma
Degree
Masters
Other:
Required
Contact number:
*
Your answer
Email
*
Your answer
Address
*
Your answer
Emergency Contact Person (Name, Relationship & Contact No.)
*
Your answer
Have you ever been treated with any psychiatric disorder?
*
Anxiety Disorders (eg. Society Anxiety Disorder, Generalized Anxiety Disorder, Panic Disorder)
Bipolar Disorder
Depression
Eating Disorders (eg. Anorexia, Bulimia, Binge Eating)
Obsessive Compulsive Disorder (OCD)
Personality Disorders (eg. Borderline Personality Disorder, Anti-Social Personality Disorder)
Psychotic Disorder / Schizophrenia
Post-Traumatic Stress Disorder (PTSD)
Not Applicable
Other:
Required
How would you like to participate in H.O.P.E Alliance?
*
Peer Learning Circle (Peer Support Group)
Interest Groups (Sports & Wellness, Creative Arts, Music & Singing, Drama Club, Guitar Class)
Monthly Life Skills Workshops (Stress Management, Self-Care, Coping With Depression, etc)
Signature Events (Music Fest of HOPE, Mental Health Seminar, etc)
Strengths-Oriented Recovery Coaching / Positive Psychotherapy
Complimentary counselling with ECTA counselling interns (terms and conditions apply)
Volunteer with H.O.P.E. Alliance
Other:
Required
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