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Enrollment Form
(All Fields marked with
*
are mandatory)
Personal Details
Title *
-Select-
Ms.
Mrs.
Mr.
Dr.
Prof.
Col(Retd)
Capt.
Col
Lt.Col.
Brig
Sh.
Mr & Mrs
First Name *:
Last Name *:
Date of Birth :
Marital Status
-Select-
Married
Single
Name of Spouse
Wedding Aniversary
Spouse Birth Date
Company Details
Name of Organization *
Department *
Designation*
Business Address *
Phone Number *
Select Country *
--Select Country--
India
Others
United Arab Emirates
Select State *
--Select State--
Select City *
--Select City--
PIN Code *
Preferred Email *
Residential Details
Residential Address
Select Country
--Select Country--
India
Others
United Arab Emirates
Select State
--Select State--
Select City
--Select City--
PIN Code
Preferred Address
of Communication *
Residential Address
Business Address
Phone Number
Mobile Number *
Alternate Email
Are you a member of any other program similar to Connections *
Yes
No
(If yes, please specify)
1.
2.
Who else in your organisation books hotel rooms?
Sr. No.
Name & Designation
Contact No.
1.
2.
Relationship Manager
Relationship Manager
I have read and accept the '
Terms and Conditions
' of the CONNECTIONS Program.
Date of Birth
:
Existing Membership(s)
:
Other
Interests
:
Other
Member type
:
Travel Agent
Booker
Sales Person
:
Sales Region
:
Hotel
:
Sales Head
:
Sales Director
: