CLUB STOMP CARD APPLICATION FORM
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Title:
Gender:
*Surname:
*Given Name:
Name To Appear On Card:
*NRIC/Passport No:
*Date of Birth:
*Marital Status:
*Nationality:
*Block/House No:
*Street Name/Building Name:
Unit No:
*Postal Code:
*Telephone (Mobile):
Telephone (Home):
Telephone (Office):
*Email:
*Occupation:
Interest(s):
(You may tick more than one)
Clubbing
Shopping
Health & Beauty
Travel
Movies
Fashion
Sports
Dinning
How would you like us to contact you?
I understand and agree that personal and other information about me, including my use of the card, will be collected by www.stomp.com.sg and may be disclosed to Programme Partners for the administration of the programme and for researching, promoting and marketing goods or services of STOMP or the Programme Partners. I also authorise STOMP and the Programme Partners to use my details to check or enhance information held on their consumer database and to disclose this database to third parties for marketing purposes. I have read and agreed to the above. I have acknowledged this by signing this enrolment form that I accept and agree to be bound by the Club STOMP programme Cardholder Terms and Conditions.