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Revaluation Rewards Limited

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Registration For Membership

Registration For Membership

Which Membership You Want Registration ?

Registration For Membership

MEMBER TYPE

VIP FIRST CLASS
VIP ICON
HEALTH MEMBERSHIP
PLATINUM

Joining Date

NAME OF CARD

Date of Birth

Marriage Date

Company Name

Designation

Office Address

Home Address

Mobile Number

Alternative Phone Number

Email

NID/PASSPORT

Select Package for Cake

BIRTHDAY
MARRIAGE DAY
SPECIAL DAY

Cake Delivery Date

Payment Method

Cash
Cheque
VISA/ Mastercard/ Nexus/ JCB
bKash/ Rocket/ Nagad
Money Transfer

Bank Name

Cheque/Credit Card Number

Cheque Date

Amount (BDT)

Special Request

Comments

MEMBERSHIP SURVEY Just before you go, I just have a few questions so that we can do something special for you

Where do you travel within Bangladesh?

Dhaka
Chittagong
Rajshahi
Khulna
Sylhet
Cox's Bazar
Barisal

Holiday Destination in Abroad

Which Hospital do you like?

What type of party do you like?

Dj
Ramp Show
Dance
All of Above

Do you Smoke?

YES
NO

Do you Drink?

No
Occasionally
Regular

Spouse Card Holder

Declaration "I hereby do declare that i understand by becoming a member of the Revaluation, I shall be entitled to certain privileges and be subject to the usual Revaluation rules,regulations and policy made by the management of the establishment.

Signature of Member

Thank You ...

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