FGR REGISTRATION
Items marked with
*
are mandatory
MY PERSONAL PARTICULARS
Title:
Mr.
Ms.
Mrs.
Dr.
Other:
First Name:
*
Last Name:
*
Preferred
Name on Card:
*
Date of Birth:
Gender:
*
Female
Male
(dd/mm/yyyy)
Nationality:
*
AFGHANISTAN
ÅLAND ISLANDS
ALBANIA
ALGERIAN
AMERICAN
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTIGUA & BARBUDA
ARGENTINE
ARMENIAN
ARUBA
AUSTRALIAN
AUSTRIAN
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA-HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZILIAN
BRITISH
BRITISH INDIAN OCEAN TERR
BRITISH VIRGIN ISLANDS
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURMA
BURUNDI
CANADIAN
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILEAN
CHINESE
CHRISTMAS ISLAND
COCOS (KEELING) ISLAND
COLOMBIAN
COMOROS
CONGO
COOK ISLANDS
COSTA RICA
COTE D'IVOIRE
CROATIAN
CUBA
CYPRUS
CZECH
CZECHOSLOVAKIA
DEMOCRATIC KAMPUCHEA
DENMARK
DJIBOUTI
DOMINICA
EAST TIMOR
ECUADOR
EGYPTIAN
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIAN
ETHIOPIA
FAEROE ISLANDS
FALKLAND ISLANDS-MALVINAS
FIJI
FINLAND
FRENCH
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIAN
GERMAN
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD & MCDONALD ISLAND
HONDURAS
HONG KONGER
HUNGARY
ICELAND
INDIAN
INDONESIAN
IRANIAN
IRAQ
ISLE OF MAN
ISRAEL
ITALIAN
JAMAICAN
JAPANESE
JERSEY
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEM. REP.
LATVIAN
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA
MADAGASCAR
MALAWI
MALAYSIAN
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
Mayotte
MEXICAN
MICRONESIA, FEDERATED STATES O
MIDWAY ISLANDS
MOLDOVA
MONACO
MONGOLIA
MONTENEGRIAN
MONTSERRAT
MOROCCO
MOZAMBIQUE
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIAN
NIUE
NORFOLK ISLAND
NORTH KOREAN
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTANIAN
PALAU
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PERU
PHILIPPINES
PITCAIRN
POLISH
PORTUGAL
PUERTO RICO
QATAR
REPUBLIC OF IRELAND
REPUBLICA DOMINICANA
REUNION
ROMANIAN
RUSSIAN
RWANDA
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIAN
SENEGAL
SERBIAN
SEYCHELLES
SIERRA LEONE
SINGAPOREAN
SLOVAK REPUBLIC
SLOVENIA
SOLOMON ISLANDS
SOMALIAN
SOUTH AFRICAN
SOUTH KOREAN
SPAINISH
SRI LANKA
ST. HELENA
ST. KITTS-NEVIS-ANGUILLA
ST. LUCIA
ST. PIERRE AND MIQUELON
ST. VINCENT & GRENADINES
SUDAN
SURINAME
SVALBARD & JAN MAYEN IS.
SWAZILAND
SWEDISH
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWANESE
TAJIKISTAN
THAILAND
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKISH
TURKMENISTAN
TURKS & CAICOS ISLANDS
TUVALU
U.S. VIRGIN ISLANDS
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED REP. OF CAMEROON
UNITED REP. OF TANZANIA
UNKNOWN
URUGUAY
UZBEKISTAN
VANUATU
VATICAN CITY STATE
VENEZUELA
VIETNAMESE
WALLIS AND FUTUNA ISLANDS
WESTERN SAHARA
YEMEN ARAB REPUBLIC
ZAIRE
ZAMBIA
ZIMBABWE
Job Title:
Executives
Software Engineer
Professional
Engineer
Self-Employed
Company Name:
*
Please type in NA if this section is not applicable
Mailing Address:
*
Home
Business
Address 1:
*
Address 2:
Address 3:
Address 4:
City:
State:
Country:
AFGHANISTAN
ÅLAND ISLANDS
ALBANIA
ALGERIA
AMERICAN SAMOA
ANDORRA
ANGOLA
ANGUILLA
ANTIGUA & BARBUDA
ARGENTINA
ARMENIA
ARUBA
AUSTRALIA
AUSTRIA
AZERBAIJAN
BAHAMAS
BAHRAIN
BANGLADESH
BARBADOS
BELARUS
BELGIUM
BELIZE
BENIN
BERMUDA
BHUTAN
BOLIVIA
BOSNIA-HERZEGOVINA
BOTSWANA
BOUVET ISLAND
BRAZIL
BRITISH INDIAN OCEAN TERR
BRITISH VIRGIN ISLANDS
BRUNEI DARUSSALAM
BULGARIA
BURKINA FASO
BURMA
BURUNDI
CANADA
CAPE VERDE
CAYMAN ISLANDS
CENTRAL AFRICAN REPUBLIC
CHAD
CHILE
CHRISTMAS ISLAND
COCOS (KEELING) ISLAND
COLOMBIA
COMOROS
CONGO
COOK ISLANDS
COSTA RICA
COTE D'IVOIRE
CROATIA
CUBA
CYPRUS
CZECH REPUBLIC
CZECHOSLOVAKIA
DEMOCRATIC KAMPUCHEA
DENMARK
DJIBOUTI
DOMINICA
EAST TIMOR
ECUADOR
EGYPT
EL SALVADOR
EQUATORIAL GUINEA
ERITREA
ESTONIA
ETHIOPIA
FAEROE ISLANDS
FALKLAND ISLANDS-MALVINAS
FIJI
FINLAND
FRANCE
FRENCH GUIANA
FRENCH POLYNESIA
FRENCH SOUTHERN TERRITORIES
GABON
GAMBIA
GEORGIA
GERMANY
GHANA
GIBRALTAR
GREECE
GREENLAND
GRENADA
GUADELOUPE
GUAM
GUATEMALA
GUERNSEY
GUINEA
GUINEA-BISSAU
GUYANA
HAITI
HEARD & MCDONALD ISLAND
HONDURAS
HONG KONG
HUNGARY
ICELAND
INDIA
INDONESIA
IRAN
IRAQ
ISLE OF MAN
ISRAEL
ITALY
JAMAICA
JAPAN
JERSEY
JORDAN
KAZAKHSTAN
KENYA
KIRIBATI
KUWAIT
KYRGYZSTAN
LAO PEOPLE'S DEM. REP.
LATVIA
LEBANON
LESOTHO
LIBERIA
LIBYAN ARAB JAMAHIRIYA
LIECHTENSTEIN
LITHUANIA
LUXEMBOURG
MACAU
MACEDONIA
MADAGASCAR
MALAWI
MALAYSIA
MALDIVES
MALI
MALTA
MARSHALL ISLANDS
MARTINIQUE
MAURITANIA
MAURITIUS
Mayotte
MEXICO
MICRONESIA, FEDERATED STATES O
MIDWAY ISLANDS
MOLDOVA
MONACO
MONGOLIA
MONTENEGRO
MONTSERRAT
MOROCCO
MOZAMBIQUE
NAMIBIA
NAURU
NEPAL
NETHERLANDS
NETHERLANDS ANTILLES
NEW CALEDONIA
NEW ZEALAND
NICARAGUA
NIGER
NIGERIA
NIUE
NORFOLK ISLAND
NORTH KOREA
NORTHERN MARIANA ISLANDS
NORWAY
OMAN
PAKISTAN
PALAU
PANAMA
PAPUA NEW GUINEA
PARAGUAY
PEOPLE'S REP. OF CHINA
PERU
PHILIPPINES
PITCAIRN
POLAND
PORTUGAL
PUERTO RICO
QATAR
REPUBLIC OF IRELAND
REPUBLICA DOMINICANA
REUNION
ROMANIA
RUSSIA
RWANDA
SAMOA
SAN MARINO
SAO TOME AND PRINCIPE
SAUDI ARABIA
SENEGAL
SERBIA
SEYCHELLES
SIERRA LEONE
SINGAPORE
SLOVAK REPUBLIC
SLOVENIA
SOLOMON ISLANDS
SOMALIA
SOUTH AFRICA
SOUTH KOREA
SPAIN
SRI LANKA
ST. HELENA
ST. KITTS-NEVIS-ANGUILLA
ST. LUCIA
ST. PIERRE AND MIQUELON
ST. VINCENT & GRENADINES
SUDAN
SURINAME
SVALBARD & JAN MAYEN IS.
SWAZILAND
SWEDEN
SWITZERLAND
SYRIAN ARAB REPUBLIC
TAIWAN
TAJIKISTAN
THAILAND
TOGO
TOKELAU
TONGA
TRINIDAD AND TOBAGO
TUNISIA
TURKEY
TURKMENISTAN
TURKS & CAICOS ISLANDS
TUVALU
U.S. VIRGIN ISLANDS
UGANDA
UKRAINE
UNITED ARAB EMIRATES
UNITED KINGDOM
UNITED REP. OF CAMEROON
UNITED REP. OF TANZANIA
UNITED STATES OF AMERICA
UNKNOWN
URUGUAY
UZBEKISTAN
VANUATU
VATICAN CITY STATE
VENEZUELA
VIETNAM
WALLIS AND FUTUNA ISLANDS
WESTERN SAHARA
YEMEN ARAB REPUBLIC
ZAIRE
ZAMBIA
ZIMBABWE
Zip Code:
*
Phone:
Fax:
Mobile:
*
Email:
*
(e.g. lim@yahoo.com.sg)
MY PREFERENCES
Bed Type:
No Preference
King
Queen
Twin
Smoking:
No Preference
Non Smoking
Smoking
Room Location:
No Preference
High Floor
Low Floor
Near Elevator:
No Preference
Yes
No
Newspaper:
No Preference
No
Yes:
Do you wish to receive Email updates and offers from M&C:
*
Yes
No
Do you wish to receive Direct Mail updates and offers from M&C:
*
Yes
No
MY REFERRAL
How did you come to know about M&C Loyalty Club ?
Referred by Hotel(s):
Participating Hotel
Others
Media(s):
Newspaper
Magazines
TV / Radio
Other(s):
Friends / Relatives
Travel Agents
Secretaries / Admin Assistants
I have read and agreed to abide by the
Terms and Conditions
of M&C Loyalty Club.
*
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