1. Application's Information - All fields are compulsory to fill in
       
  Full Name
  Name to Appear on Card
  Home Address
  Postcode  City  
  Country
  I.C No/ Passport
  Nationality
  Race Malay Chinese India Others
  Date of Birth
  Sex Male Female
  Marital Status Single Married with no children Married with children
  Contact No
  Mobile
  Email
  Profession Business Owner       Secretary        Executive    Clerical
      Junior Management Non-Executive Homemaker Student
      Senior Management Professional    Others
  Gross Annual Personal Income Below RM 24,000          RM 24,0001 - RM 36,000
      RM 36,001 - RM 48,000 Above RM 48,000
  Card Owned America Express Diners Club Master Card
      Visa                   Others
  Company's Name
  Office Address
  Postcode  City  
  Country
  Contact No
  Email
  Preferred TV Stations RTM 1  RTM 2 TV 3
      NTV 7   8 TV    ASTRO
  Preferred Radio Stations Radio 3 Radio 4 Hot FM MY FM
      Mix FM Wow FM Hitz FM Era
      Light & Easy Others
  Preferred Newspaper The Star    The Sun             New Straits Times
      Malay Mail Utusan Malaysia Berita Harian
      Metro        China Press       Sin Chew Jit Poh
      Nanyang Siang Pau        Others
       
  2. Supplementary Membership's Information
       
  Full Name
  Name to Appear on Card
  I.C No/ Passport No.
  Date of Birth
  Sex Male Female
  Relationship to Principal Card Memeber   Spouse Parent Child Brother / Sister
 
 
I agree to participate and abide by the COMMUNITY CARD Terms & Conditions. I accept that any decision made with regards to this membership will befinal and no correspondence will be entertained.