*Name of Principal Member (as in NRIC/FIN):
Dr Mr Mrs Ms

*Email Address:

*Membership No.:

If you are also renewing for Family Membership, please provide details below:

Name of Family Member (as in NRIC/FIN):
Dr Mr Mrs Ms

Membership No.*:

Payment by:
Amex Visa Mastercard Diners

Credit Card No. :

Credit Card Expiry:


Note: A copy of your credit card slip will be mailed to your mailing address in our records.

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Yes! Sign me up for automatic renewal of my AA membership via credit card standing order using the credit card account as indicated above.

My choice of renewal period:

Note: Your membership will be automatically renewed upon expiry and successful deduction of the membership fees from the above designated credit card account.
Kindly ensure there are sufficient credit limit in your credit card account for debit on each due date. In the event that the standing order instruction is unsuccessful, your membership privileges will lapse. For convenience, this authorisation will continue to be in-force to ensure that your membership is renewed before expiry. Kindly notify us in writing to revoke this authorisation or if there is a change in your credit card details.

Tel. No. (Home):

Tel. No. (Office):

Handphone/Pager:

Amount: S$

Family membership will have to run concurrently with the validity period of membership of the principal member.

Roadside Assistance Service is available only to petrol-driven saloon cars. It is not available to taxis, motorcycles and commercial vehicles, including G-plated vans.

Please do not submit twice.