Supporter’s Club Application Form

Please fill in the application form below.

■About Payment

【Transfer】or【Credit Card (VISA or Master)】

You will receive an email regarding payment and the member’s benefits from the club.

Applicant

*Required field

Mr. or Ms.*
Name*
Date of Birth*
Occupation*
Home Address*
Telephone*
HP*
E-mail*
Payment Type*
Remarks

Family

↓If you would like to apply for your family at the same time,please fill in below too.

1st Family Member

Mr. or Ms.
Name
Date of Birth
HP
E-mail

2nd Family Member

Mr. or Ms.
Name
Date of Birth
HP
E-mail

3rd Family Member

Mr. or Ms.
Name
Date of Birth
HP
E-mail

4th Family Member

Mr. or Ms.
Name
Date of Birth
HP
E-mail

【Attentions】
*This membership is only valid from the date of application until 31st December 2016.
*Please note that membership fee is not refundable for any reason whatsoever, once you made a payment.
*Club will not re-issue the season pass even in case of any losses or damages,so please handle with care.
*By signing up as a Supporters Club member, you will become a member of ALBIREX.S Clubhouse, subject to the expiry date of this membership. If you do not wish to be member of ALBIREX.S Clunhouse, please write “I do not wish to be member of ALBIREX.S Clunhouse” in Remarks column.