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Name
*
TAN SRI
PUAN SRI
DATUK SRI / DATO SRI
DATIN SRI
DATUK / DATO
DATIN
PROF.
DR.
MR.
MRS.
MS.
NONE
Prefix
First Name
Last Name
NRIC / Passport Number
*
No symbols required
Birth Date
*
-
Day
-
Month
Year
Mobile Phone Number
*
-
Country Code
Phone Number
Email
*
example@example.com
Mailing Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Please Select
Afghanistan
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
The Bahamas
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Belgium
Belize
Benin
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Bhutan
Bolivia
Bosnia and Herzegovina
Botswana
Brazil
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Burkina Faso
Burundi
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Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
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Colombia
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Cote d'Ivoire
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Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
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El Salvador
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Ethiopia
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Faroe Islands
Fiji
Finland
France
French Polynesia
Gabon
The Gambia
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Ghana
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Guadeloupe
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Guatemala
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Guinea
Guinea-Bissau
Guyana
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Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Israel
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Jamaica
Japan
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Kiribati
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Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
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Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Nagorno-Karabakh
Namibia
Nauru
Nepal
Netherlands
Netherlands Antilles
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
Turkish Republic of Northern Cyprus
Northern Mariana
Norway
Oman
Pakistan
Palau
Palestine
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn Islands
Poland
Portugal
Puerto Rico
Qatar
Republic of the Congo
Romania
Russia
Rwanda
Saint Barthelemy
Saint Helena
Saint Kitts and Nevis
Saint Lucia
Saint Martin
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Slovakia
Slovenia
Solomon Islands
Somalia
Somaliland
South Africa
South Ossetia
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard
eSwatini
Sweden
Switzerland
Syria
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Transnistria Pridnestrovie
Trinidad and Tobago
Tristan da Cunha
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
Uruguay
Uzbekistan
Vanuatu
Vatican City
Venezuela
Vietnam
British Virgin Islands
Isle of Man
US Virgin Islands
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Other
Country
Marital Status (Select One)
*
Single
Married
No. of Children
*
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Business / Employment Information
Company Name
*
Position
*
Annual Income (In USD)
*
30,000 to 90,000
More than 90,000
Nature Of Business / Industry
*
(Select One)
Food & Beverages
Travel & Tourism
Entertainment & Recreation
Golf & Sports
Luxurious Amenities
Fashion & Lifestyle
Health, Beauty & Fitness
Automotive
Technology & Gadgets
Property
Art & Culture
Investment & Education
Others
Nature Of Business / Industry (For Others)
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Declaration
Upon submission of the LUXURIATE CLUB Membership Form, I declare that all the information furnished above is true and correct. I hereby allow BESPOKE INTERNATIONAL GROUP SDN BHD to utilize all the information provided by my company and I at its sole discretion for the LUXURIATE CLUB's use. I acknowledge and understand that there are Terms & Conditions applicable for the said club.
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