Type of Membership:

Please Select One: - - - - - - - - - - - - Individual Couple

Salutation :

Mr Mrs Ms Dr

Surname :

Other Names in Full :

Name to Appear in Card :

Passport / ID Number :

Nationality :

Date of Birth (Day/ Month/ Year) :

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 January February March April May June July August September October November December 1986 1985 1984 1983 1982 1981 1980 1979 1978 1977 1976 1975 1974 1973 1972 1971 1970 1969 1968 1967 1966 1965 1964 1963 1962 1961 1960 1959 1958 1957 1956 1955 1954 1953 1952 1951 1950 1949 1948 1947 1946 1945 1944 1943 1942 1941 1940 1939 1938 1937 1936 1935 1934 1933 1932 1931 1930 1929 1928 1927 1926 1925 1924 1923 1922 1921 1920 1919 1918 1917 1916 1915 1914

Place of Birth :

Current Home Address :

Home Phone Number :

  Please include country and area codes

Mobile Phone Number :

  Please include country and area codes

Fax Number :

  Please include country and area codes

E-mail Address:

Martial Status :

Please Select One: - - - - - - - - - - - - Single Married Divorced Widowed

Wedding Anniversary (Optional):

Company Name :

Nature of Business :

Business Address :

Business Phone Number :

  Please include country and area codes

Designation :

Length of Employment :

Mailing Address :

Home         Company

Billing Address :

Home         Company

For non-locals, Date of Arrival :

(DD/MM/YY)       Intended Length of Stay :

1.         Telephone Number :

2.         Telephone Number :

3.         Telephone Number :

Name of Next-of-Kin :

Address :

Telephone Number :

  Please include country and area codes

Relationship with Next-of-Kin :

Payment Mode :

Cash         Credit Card

I hereby declare that the above information to be true and correct. I acknowledge that I have received, read and understood all the rules, term and condition (**Pls make a link to our term and condition) of The Pearl Beauty & Spa and its Spa Membership program and I confirm that, upon confirmation of my membership, my endorsement herein forms a binding agreement between myself and The Pearl Beauty & Spa in accordance with the terms herein and as amended by The Pearl Beauty & Spa from time to time. I hereby agree to abide and be bound by all rules, terms and conditions of The Pearl Beauty & Spa and its Spa Membership program.

I agree (please tick).