Membership Form

Membership Form Please print this membership form, fill it out, and hand it in person at our main office: First Name: __________________________ Last Name: ___________________________ Gender: Male

Female

Birthday: Date______ Month _______ Year _____ Membership Type: ____ Silver (yearly subscribe at 2,000 BHT) ____ Gold (yearly subscribe at 3,200 BHT) ____ Platinum (yearly subscribe at 4,500 BHT) Identification Number/Passport Number: ________________________________ Telephone Number: ________________________________ E-mail Address: _________________________________ Home Address: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Office Address: ___________________________________________________________________________ ___________________________________________________________________________ ___________________________________________________________________________ Signature _______________________ Date _______________________