Guardian Malaysia: golden privilege card application

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	Now especially for senior citizens, Guardian has another way of saying "We care". We offer you an exclusive Golden Privilege Card which is yours, absolutely FREE. This card entitles you to discounts on health products at all Guardian stores. You have to be 55 years and above to qualify for membership.



	*Salutation:

	*Name:

	*Date of Birth:		(Eg. YYYYMMDD)

	*Nationality:

	*NRIC:		(Eg. 800507-14-1234 for Malaysian)

	Gender:		Male Female

	Race:

	*Home Address:

	*Postcode:

	*State:

	*Town:

	*Country:

	*Home Tel:

	*Occupation:

	Preferred Store:		Please choose your favourite store

	*Collection Store:		Please choose the store you wish to collect your card from

	*Registration:		New Registration Renewal

	*Email Address:		(This will be used as your user login ID)

	*Password:

	*Re-type password:

	*Compulsory fields



	Important: During collection of membership card, the applicant must produce their Identification Card* for verification.