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FBTC Membership Enrolment Form

PLEASE NOTE
We have a 24 hour response policy. If you have not received
a reply from us within 24 hours please send us an email.

YES...
Please enrol me as an FBTC member at the new member fee of
US$97.50 (plus US$7.50 postage and handling charge)

Title         :  
First Name    : 
Middle Name   : 
Family Name   : 
Email         : 
Please confirm your 
email address : 

Print your name here as to be shown on your membership card.
                
Home Address : Home Phone No.: Home Fax No. : Profession : Job Title : Place of Birth: Date of Birth : Nationality : Passport No. : (This personal information is kept strictly confidential and used for the issue of your membership material.) Business Address Company Name : Address : Phone No. : Fax No. : Email. : I prefer my communications at my : Business Address. Home address. TO EXPEDITE your application, complete and submit this form or, print and
email your enrollment form to us. We will process your membership within
24 hours (subject to credit card approval) Please charge my membership fee to the following credit card : Credit card guarantee First Choice : Credit Card No: Exp. Date : Second Choice : Credit Card No: Exp. Date : Name as it appears on your credit card and billing address : Name : Address : City : State : Zip : Country : Internet Membership Renewals are automatically renewed to your
credit card annually. Twenty one days prior to the expiry of your
membership and prior to charging the renewal fee to your credit card,
we will contact you to remind you that your membership is due for
renewal and advise you of the credit card renewal charge. At this time
you can change the status of your membership if you wish. Do you wish to be reminded 21 days prior to renewal date: Date :

Click here to Contact FBTC by E-mail

Frequent Business Travellers Club

Postal Address:
P.O Box 6238,
Coffs Harbour Plaza LPO,
Coffs Harbour
N.S.W. 2450, Australia.
Tel: (61 2) 6656 4934. Fax: (61 2) 6656 4934.

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