Please complete the enrolment form below. This information is required in order to approve the application and to proceed with the processing of the membership card.
Denotes required information.
 Basic Information (please complete all mandatory fields)
Salutation/Name
Salutation First Name Last Name
Gender
Male
Female
Date of Birth
Contact No
Country
Code		 Area
Code		 Phone Number
Country of
Residence
Nationality

(As in your passport)
 Login Information (please complete all mandatory fields)
Email Address
 (This is your login ID)
Password
 (minimum 6 characters)
Confirm Password
 Secondary Information (optional fields – please share your information with us)
Marital Status
Single
Married
Wedding Anniversary
Identity Card No
Company Name
Position
Industry Type
Address
Home
Business

Address 1

Address 2
City
State/Country
Zip/Postal Code
Phone No
Country
Code		 Area
Code		 Phone Number
Fax No
Country
Code		 Area
Code		 Phone Number
 Preferences (optional fields – please share your preferences with us)
Hold CTRL key to select multiple preferences
Culinary Preference
Event Preference
Hobbies/ Interests Preference
 Enrolment Completion (please complete all mandatory fields)
The following three boxes must be checked before your membership request can be processed.


I have read,understood and agree to be bound by the terms and conditions of the programme.
I agree that the points accumulation will only be activated when the membership is awarded.


I have given Pan Pacific Singapore the permission to send any notice or communication addressed to me concerning the programme and my account to any home or office address, email address, mobile phone, fascimile transmission details provided.
For security purposes, there will be a verification email sent instantly after submitting the enrolment form. This must be activated as the final step to confirm your registration details.