Member Registration | CLUB Panasonic

MEMBERSHIP REGISTRATION

*Mandatory Fields

1. PERSONAL INFORMATION
Title/Salutation
First Name *
Please enter your first name.
Last Name *
Please enter your last name.
Email Address *
Please enter a valid email address.
Preferred Name in Communication *
Please enter a preferred name. We will use this name in all communications.
Gender *
Race
Type of Identification*
Identification Number*
Please enter your identification number based on the identification type selected earlier.<br>Example: 740929-01-xxxx
Date of Birth *
    
Address 1 (Street) *
Please enter your address.
Address 2 (Street)
Please enter address line 2 (if applicable).
Address 3
Please enter address line 3 (if applicable).
City *
Please enter your city name.
State *
Post Code *
Please enter your Zip / Postal Code.
Country *
Country is set by the System and cannot be changed.
Mobile Phone Number *
Please enter your mobile phone number. Example: 01X-XXXXXXX
2. Promotional Information:

Please check on the boxes if you do not wish to receive any of the communications below.

CLUB Panasonic electronic newsletter

CLUB Panasonic events

CLUB Panasonic campaign & promotions

CLUB Panasonic surveys & questionnaires

CLUB Panasonic short messaging service (SMS)

I have read and agreed on the Terms and Conditions. I also agree to receive a monthly e-point electronic statement from CLUB Panasonic. *