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Angsana Spa & Emirates Hills

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Angsana Spa Membership Application Form
Please note that this is not a confirmation of your reservation. Confirmation will be carried out once all the conditions required are met and acknowledged by both parties. (You need IE 5.0 or above / Netscape 6.0 or above in order to use this form. The * fields are optional)

Angsana Spa Emirates Hills Town Centre Meadows Drive Dubai United Arab Emirates Tel: + 971 4 368 3222 Fax: +971 4 368 2022 Email: spa-emirateshills@angsana.com Mailing address: Angsana Spa & Health Club Dubai Marina PO Box 102973 Dubai, United Arab Emirates

Type of Membership:
Personal Information
Salutation :
Surname :
Other Names in Full :
Name to Appear in Card :
Passport / ID Number :
Nationality :
Date of Birth (Day/ Month/ Year) :
Place of Birth :
Current Home Address :
Home Phone Number :	Please include country and area codes
Mobile Phone Number :	Please include country and area codes
Fax Number :	Please include country and area codes
E-mail Address:
Martial Status :
Wedding Anniversary (Optional):
Professional Information
Company Name :
Nature of Business :
Business Address :
Business Phone Number :	Please include country and area codes
Designation :
Length of Employment :
Mailing Address :	Home Company
Billing Address :	Home Company
For non-locals, Date of Arrival :	(DD/MM/YY) Intended Length of Stay :
Membership in Other Clubs Please provide Club Name and Telephone Number
1. Telephone Number :
2. Telephone Number :
3. Telephone Number :
For Emergency Purposes
Name of Next-of-Kin :
Address :
Telephone Number :	Please include country and area codes
Relationship with Next-of-Kin :
Payment Mode
Payment Mode :	Cash Credit Card

Declaration of Applicant	I hereby declare that the above information to be true and correct. I acknowledge that I have received, read and understood all the rules, terms and conditions of Angsana Spa and its Spa Membership program and I confirm that, upon confirmation of my membership, my endorsement herein forms a binding agreement between myself and Angsana Spa in accordance with the terms herein and as amended by Angsana Spa from time to time. I hereby agree to abide and be bound by all rules, terms and conditions of Angsana Spa and its Spa Membership program. I agree (please tick).

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