International Associate Clubs

Card Acknowledgement

Member Name:

Email Address:

Telephone No.:

Country Code		Area Code		Telephone Number

Membership No.:

* Club Code: * Compulsory Field *

Date of Birth:

DD	MMM	YYYY

Residence Address:

I confirm that the information given above is correct and complete and authorise you to confirm this from any source IAC may choose. I also acknowledge that the use of this membership card(s) are subject to the terms and conditions of International Associate Clubs.