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PLEASE PRINT
Individual Name :________________________________________________
Mailing Address:_______________________________________________
_________________________________________ __ ___
Phone:(___)_________________E-mail: __________________________
Fax:(___)__________________Web: ___________________________
Spouse Name if joint Application __________________________________
Profession or Occupation: __________________________________________
I/We apply for membership in Chiang Mai Friends Group and understand that this application is subject to acceptance and approval. By signing, I/we authorize Chiang Mai Friends Group or its duly authorized agent to verify this information on me/us. Upon acceptance, this application shall become a binding agreement between me/us and Chiang Mai Friends Group. I/we acknowledge receiving a copy of the Rules and Regulations and agree to abide by the Rules and Regulations as established and amended from time to time. I/We agree to pay an Initial Membership Fee of THB 500 and an Annual Service Fee of THB 500 cash.
Signature:____________________________Date: __________________
Name on Membership Card:_________________________________________
Referred By: ________________________Telephone____________________
Email : ____________________________________________________
Approved by Chiang Mai Friends Group:____________________
Date: _____________
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