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Doublefocus
MEMBERSHIP FORM
CATEGORY OF MEMBERSHIP
Corporate Membership
Every Additional corporate Nominee
Life Membership
Permenant Membership
Executive Membership
Annual Membership
select
MEMBER/NOMINEE NAME
SURNAME
DATE OF BIRTH
(dd/mm/yyyy)
NATIONALITY
MARITAL STATUS
Married
Unmarried
PASSPORT NO.
I.T.PAN NO.
RESIDENTIAL ADDRESS
TEL
FAX
EMAIL
Your Business Details
NAME OF COMPANY
NATURE OF BUSINESS
ADDRESS
TEL
FAX
EMAIL
DATE OF WEDDING ANNIVERSARY
OTHER CLUB MEMBERSHIPS
SPOUSE
NAME
DATE OF BIRTH
NATIONALITY
PASSPORT NO.
I.T.PAN NO
SPOUSE BUSINESS DETAILS
NAME OF COMPANY
NATURE OF BUSSINESS
DESIGNATION
BUSINESS ADDRESS
TEL
FAX
EMAIL
CHILDREN DETAILS
NAME
D.O.B
Male
Female
Payment
Full payment based on category applied for to accompany Membership Form
I prefer club Mailing to be sent to
Residence
Office
I prefer club Monthly Statement to be sent to
Residence
Office
Dependant Card to
Please arrange issue dependant card to
Terms & Condition of Membership and Rules of
L'AMICALE
As A Member/Corporate designee , I agree to comply with and be bound by the terms & condition of Membership and rules of L'AMICALE as the same may from time to time be in force.
I Accept
