Citrus

Enrollment Form

* All fields are mandatory otherwise mentioned

Enrollment date *

:

(dd-mmm-yyyy)

Firm Name *

:

Designation/Department

:

Name *

:

Gender * :

PAN No.*

:

Company Service Tax No.*

:

Mobile No.*

:

Phone with STD Code*

Contact Detail

Member Mailing Address:

Address Line 1*

:

Address Line 2

:

Post Office *

:

Land Mark *

:

Village /City/Town *

:

Others

:

District *

:

Pin Code *

:

State *

:

Email Id

:

Residential Mailing Address same as above

Address Line 1 *

:

Address Line 2

:

Post Office *

:

Land Mark *

:

Village /City/Town *

:

Others

:

District *

:

Pin Code *

:

State *

:

Personal Details :

Religion

HinduMuslimCatholicSikhParsi Other

Date of Birth *

:

Marital Status * :

YesNo

If Married, Anniversary Date

:

Spouse Name *

:

Spouse Date of Birth *

Booker Business Details

Other Business Type

:

ServiceTravel PortalRetail

Other

Other hotel bookings done:

Hotel 1		Hotel 2
Hotel 3		Hotel 4
Hotel 5

Interests :

BooksMovieMusicSportsTheatreTravel Other

I have read and accept the 'Terms and Conditions' of the Citrus Program.


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