Membership Registration Form
Supreme Choice Enterprise
_____
Tel: 018-8471843

Use this form to become a member of Supreme Choice Enterprise where you will have complete access to our client data.
Service:
1. A membership period is either 3 months, 6 months, 1 year or combinations and multiples of it.
2. The international membership fee is: 3 month = US$50.00, 6 month = US$90.00, 1 year = US$150.00 .
3. The national (Malaysia) membership fee is: 3 month = RM120.00, 6 month = RM220.00, 1 year = RM400.00 .
4. As a member we provide you with all the details of our clients.
5. Our international members are updated weekly (Email account required).
6. For our national members we provide montly updated mailed issues.
7. We do never release any kind of information of our members to any third party.
8. Your membership will be confirmed with Email/Fax/Letter.
Conditions:
1. We cannot quaranty success in getting married and finding the right life partner, yet we strive to make it happen.
2. Unused membership periods are not refundable. 
 
Name:                  ___________________________________________________ 

NRIC/Passport No:      ___________________________________________________ 

Nationality:           ______________________   Sex: _____________________ 

Address:               ___________________________________________________ 

                       ___________________________________________________ 

Country:               ___________________________________________________ 

Email:                 ___________________________________________________ 

Phone:                 ______________________   Fax: _____________________ 

Membership duration:   __ 3 months  __ 6 months  __ 1 Year  Others: ______ 

Starting Date:         ___________________________________________________ 

Payment                __ Amex     __ Visa     __ Diners     __ MasterCard 

Credit Card No.:       ___________________________________________________ 

Expiry:                ___________________________________________________ 

Amount:                ___________________________________________________ 

How did you find us:   __ Search Engine     __ Newsgroup     __ Classified 

                       __ Others (please specify): _______________________
I understand that Supreme Choice Enterprise does not personally screen applicants, or verifies information provided, so I agree to take normal precautions when meeting individuals thru the Supreme Choice Service. I hereby indemnify and agree to hold Supreme Choice Enterprise, its owners, its employees and its licensees harmless from any and all claims of damage whatsoever, resulting from any introduction. I am neither allowed to publish nor distribute any data of Supreme Choice Enterprise's clients or to use it commercially and I agree to be held liable for any loss or damage including legal costs incurred as a result of it. 

Date and Signature:    ___________________________________________________
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