Membership Application Form

Applicant Information

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* 1. Full Name

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* 2. Date of Birth (DD/MM/YYYY)

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* 3. Sex

Male

Female

Non Binary

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* 4. Phone Number

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* 5. Email Address

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* 6. Occupation

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* 7. Employer's Name

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* 8. Preferred Method of Contact

Phone

Email

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* 9. Type of Membership

Individual

Family

Corporate

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* 10. Membership Duration

Monthly

Quarterly

Annual