APPLICATION FORM – TERM MEMBERSHIP

Name *

Email Address *

Phone No. *

Home Address *

NRIC or Passport No. *

Date of Birth *

Age *

Nationality *

Marital Status *
MarriedSingle

Gender *
MaleFemale

Name of Spouse

Spouse NRIC/Passport No

Name of children and date of birth ( below 21 years old )

1. Name

D.O.B

2. Name

D.O.B

3. Name

D.O.B

Please upload photo (passport size) *
File type: JPG / PNG / PDF; Max file size: 5mb

Occupation *

Name of Employer / Firm *

Office Address *

Office Telephone No. *

Office Fax.

Email *

Monthly Income *

TIN No. *

Membership from other Clubs

Handicap Index (if any )

I declare that the above information given by me is true and complete. I agree to abide by the Rules and Regulations of KGPA and the Bye Laws therein. I further agree that the Club reserves the right to revoke my membership if any of the above information given is found to be false.