MEMBERSHIP APPLICATION
FATU-HIVA International Inc.
To be completed by the Club ONLY
Applicant's (s) details:
A. Number:
FH
Counter
Title
Surname (s)
First Name (s)
1
2
3
Mailing Address:
City / Town
State/Province
Country
Postal Code
Home Phone Number
Cell Phone Number
Work Phone Number
Other Phone Number
E-Mail Address:
PART "A"  - Object of this Membership Application and Agreed Level
Level Applied for:
Points  / Year
Applic. Fee
Click HERE to convert to your currency
The amount obtained by converting the "Applic. Fee" to your country's currency, should be
the one shown on the AMOUNT box  of Par "B" - Payment Breakdown of this Application.
Confirm the Membership Fee in Words:
PART "B"  - Payment Breakdown
Unless otherwise specified and approved by the Club, the subscription fee due for each Level, shall be paid in the manner and/or installments agreed, as follows:
Terms
Times
Amount
Currency
Due Date
Method of Payment
For payments made by Credit Card, please provide the following information:
No spaces or dashes
Expiration Date:
Please click here below
if paying by PayPal
Card Type
Card Number
MM
YYYY
CSC
FATU-HIVA's Representative should complete this box.......
Application dated:
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PART "C"  - Terms of the Agreement
Back to Travel Services
FATU-HIVA Holiday Club
F
H