HEALTH CLUB MEMBERSHIP APPLICATION FORM

Please write clearly in block capitals

MEMBER DETAILS
Member (1) Name: Member (2)Name:

Nationality: Nationality:

Occupation: Occupation:

Date of Birth: (dd/mm/yy) Date of Birth: (dd/mm/yy)

Gender: (M/F) Gender: (M/F)

Address PO Box: Company:

Telephone: Email:

DETAILS OF CHILDREN (IF ANY)

Name: Date of Birth: (dd/mm/yy)

1.
2.
3.
4

TYPE OF MEMBERSHIP & PAYMENT

Type: Membership fee:

Individual 
Couple
Family Mode of payment:
Cash: Credit Card: Cheque:

DECLARATION & SIGNATURE

I would like to become a member of Shangri-La Hotel Qaryat Al Beri,Health Club. I acknowledge that I
have read all of the terms and conditions of membership and we accept them fully.

Signature: Date:
 KINDLY ENCLOSE 2 PASSPORT SIZE PHOTOGRAPHS AND A PASSPORT COPY WITH A VALID RESIDENCE VISA. SHOULD MEMBERSHIP BE
REJECTED, ALL FEES WILL BE REFUNDED.

OFFICE USE ONLY

Membership Type: Membership No(s)

Date: HC Manager: General/ Resident Manager: