De Rhu Beach Resort, Kuantan
De Rhu Club
Registration Form
De Rhu Club
Registration Form
Welcome to Our New Member's of De Rhu Club. Please fill up the form to enjoy our facilities
Do not enter anything in this text box otherwise your message will not be sent!
Please attached your passport photo size:
*
Full Name as in I/C:
*
I/C Number:
*
Nationality:
Current Address:
Age:
Sex
Male
Female
E-mail
*
Number Phone
*
Family Members: (list down name of family member)
Information Sources:
Friends
Newspaper
Website
Billboard
Flyers
Others ( please specify)
Please specify:
Payment Method
Cash (Bank In)
Card Credit
Credit Card Detail
Credit Card Name:
Credit Card Number:
Bank:
Card Type:
Visa
MasterCard
Card Expiry Date: (e.g:1212)
3 or 4 Digit Security Code:
Payment by Cash Please bank in your payment to De Rhu Beach Resort's account bank and refer the information below:
Bank Name: Maybank Berhad
Account Number: 556011-009145
Pay To: LKPP/DE RHU BEACH RESORT
After make your payment please email or fax a copy of bank in slip to:
Email Address: drbr@derhu.com.my
Fax Number: 09 5579002
Registration Form
