| Part 1: Principal Member's Particulars |
| Personal Information |
Membership No.
| :
|
| Salutation | :
|
| Name of Principal Member | :
|
| Name on card | :
* (Limited to 19 characters only) |
| Sex | :
|
| Marital Status | :
|
| NRIC/Passport No. | :
|
| Date of Birth | :
|
| Nationality | :
|
| Race | :
|
| Highest Qualification | :
|
| Residential Address/Contact Info |
| Residential Address | :
|
| Postal Code | : |
| Residential Tel. No. | :
|
| Mobile Phone/Pager | : |
| Email | :
|
| Profession/Company/Contact Info |
| Profession/Position | :
|
| Name of Company | :
|
| Company Address | :
|
| Company Postal Code | :
|
| Business Tel. No. | :
|
| Fax No. | :
|
| Other Particulars |
Billing &
Correspondence Address | :
|
| |
|
| Part 2: Spouse's Particulars |
| Personal Information |
| Salutation | :
|
| Name of member | :
|
| Name on card | :
* (Limited to 19 characters only) |
| Sex | :
|
| NRIC/Passport No. | :
|
| Nationality | :
|
| Date of Birth | :
|
| Highest Qualification | :
|
| Part 3: Children's Particulars |
| 1st Child Personal Information |
| Name of 1st Child | :
|
| Date of Birth | :
|
| Sex | :
|
| Birth Cert No. | :
|
| 2nd Child Personal Information |
| Name of 2nd Child | :
|
| Date of Birth | :
|
| Sex | :
|
| Birth Cert No. | :
|
| 3rd Child Personal Information |
| Name of 3rd Child | :
|
| Date of Birth | :
|
| Sex | :
|
| Birth Cert No. | :
|
| Part 4: Activity Registration |
| 1st Activity Registration |
| Activity-Selection | :
|
| Month to join Activity |
:
|
| Member Participant 1 |
: |
| Member Participant 2 |
: |
| Guest Participant 1 |
:
* (Limited to 19 characters only) |
| Guest Participant 2 |
:
* (Limited to 19 characters only) |
2nd Activity Registration |
| Activity-Selection | :
|
| Month to join Activity |
:
|
| Member Participant 1 |
: |
| Member Participant 2 |
: |
| Guest Participant 1 |
:
* (Limited to 19 characters only) |
| Guest Participant 2 |
:
* (Limited to 19 characters only) |
3rd Activity Registration |
| Activity-Selection | :
|
| Month to join Activity |
:
|
| Member Participant 1 |
: |
| Member Participant 2 |
: |
| Guest Participant 1 |
:
* (Limited to 19 characters only) |
| Guest Participant 2 |
:
* (Limited to 19 characters only) |
| . |
I/We
hereby declare that the information provided above is true and any intentional
suppression of relevant information may lead to the rejection of this application.
|
| |
|
| |