MEMBERSHIP APPLICATION FORM
DECLARATION
We/ I declare that all the particulars given are true and correct and understand that membership to the American club does not confer upon us /me any ownership of or liability for the property and assets owned by such club. We/ I agree that we are /I am personally liable for the payment of the applicable membership dues and charges incurred by us/me, our family and guests in the use of the amenities as the American club. If the person, company, partnership or unincorporated association indicated by me as being responsible for the payment of the same does not do so, then our/my liability for such payment shall be jointly and severally with such person, company, partnership or unincorporated association. It is hereby acknowledged that the sum of NT$ enclosed herewith is a non-refundable joining fee payable upon this membership application being approved.
As a member, We/I agree to comply with and be bound by the constitution and Rules
And Regulation of the club, as the same may from to time be amended and for the time being in force.
Member’s Signature
Date:
Spouse’s Signature
MEMBERSHIP APPLICATION
Card Number:
Last Name
Applicant
Spouse
Local Home
Address
Passport Number
Applicant
Spouse
Company Name
Applicant
Position
Company Name
Spouse
Position
Children’s Name
Birthplace
/ /
/ /
/ /
/ /
/ /
Anniversary Date
Food Alert
In order to file this application you must be proposed by a “Regular” ACC Member.
Name of Proposer
Card Number
Tel.
Date of Birth Residing Taipei
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□ Yes □ No
□O □H
□O □H
Member Join Date
Tel.
Blood Type
Mobil Phone No.
First
Middle
Nationality
□ Individual
□ Corporate
Birthplace
□ Additional
□ Replacement
Sex
□ M □ F
□ M □ F
Date of Birth
Tel.
E-mail Address
Business Address
Fax.
Business Address
Fax.
GUI Title and Number 公司名稱/統一編號
Deposit NT$
Bond Number
Statement Accent
Signature
You must also be seconded by a “Regular” ACC Member.
Name of Seconder
Card Number
Signature
Date:
Applicant’s Signatures
Anticipated length of stay in Taiwan
□ 1-2 years □ 2-3 years □ 3-5 years □ Other
Number of years in Taiwan to date:
Applicant
Spouse
Please list countries, dates of residence for last 10 years:
Approved by (For ACC use only)
Membership Manager
General Manager
Membership Committee Chairman
Mailing Address
Application must be accompanied by:
A. Photocopy of pertinent pages of passport (Nationality, Personal data, and Expiry date, etc.).
B. One picture of each family member
C. Copy of Chinese I.D. Card or Alien Registration Card (ARC), whichever is applicable.
If these are not available, then a letter of explanation concerning this.
Please note that you can download the application form, fill it in on your computer,
and return it to us by email (in ‘soft copy’) if you prefer.