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Membership Form
Royal Lotus Plus Membership Application Form
Please Fill in your personal details below
Surname ( Mr/Mrs/Miss/Other)
*
Fullname ( name in passport )
*
Date of Birth
*
Month
Month
Jan
Feb
Mar
Apr
May
Jun
Jul
Aug
Sep
Oct
Nov
Dec
Day
Day
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
Year
Sex:
*
Male
Female
Home Address
*
Home Phone
*
Fax
Company Name
Department
Title
Office Address
Office Phone
Office Fax
Second card and flight record to
Home
Office
E-mail Address
*
I understand to able to abide by the
Terms & Conditions
of Membership currently in force.
*
.
