Jan 2019 – Promotion ReNew Ordinary Form If you are human, leave this field blank.Applicant ParticularsSalutation *MrMrsMsMdmDrName of applicant (as in NRIC) * AA Membership No. / NRIC *Membership Expiry Date *Email Address *I would like to renew my AA Membership *3-year @ SGD270 Gift Upgrade (A): A315 AirTamer Personal Air Purifier worth SGD210 (Gift only available from 15 Mar 2020 onwards)3-year @ SGD270 Gift Upgrade (B): Hummer H3 Multifunctional Power Bank worth SGD138 and 30 Dollars AA Gift Vouchers3-year @ SGD240Gift: 80 Dollars AA Gift Vouchers2-year @ SGD160.50Gift A: 20 Dollars AA Gift Vouchers2-year @ SGD160.50Gift B: Free 1-year Personal Mobility Plus Insurance worth SGD661-year @ SGD80.25 - No gift For 2-year and 3-year renewal, applicant will receive complimentary 1-year GetDocPlus subscription. Upon successful application, you will receive an email notification from GetDoc on the following month.Fees are inclusive of GST and Entrance fee.Enter Promo code (if applicable)I would like to update my details (if applicable): Block/House No.Street NameBuilding NameFloor LevelUnit No.Postal CodeCountrySingaporeUnited States (US)United Kingdom (UK)CanadaAustraliaAfghanistanÅland IslandsAlbaniaAlgeriaAndorraAngolaAnguillaAntarcticaAntigua and BarbudaArgentinaArmeniaArubaAmerican SamoaAustriaAzerbaijanBahamasBahrainBangladeshBarbadosBelarusBelgiumBelauBelizeBeninBermudaBhutanBoliviaBonaire, Saint Eustatius and SabaBosnia and HerzegovinaBotswanaBouvet IslandBrazilBritish Indian Ocean TerritoryBritish Virgin IslandsBruneiBulgariaBurkina FasoBurundiCambodiaCameroonCape VerdeCayman IslandsCentral African RepublicChadChileChinaChristmas IslandCocos (Keeling) IslandsColombiaComorosCongo (Brazzaville)Congo (Kinshasa)Cook IslandsCosta RicaCroatiaCubaCuraÇaoCyprusCzech RepublicDenmarkDjiboutiDominicaDominican RepublicEcuadorEgyptEl SalvadorEquatorial GuineaEritreaEstoniaEthiopiaFalkland IslandsFaroe IslandsFijiFinlandFranceFrench GuianaFrench PolynesiaFrench Southern TerritoriesGabonGambiaGeorgiaGermanyGhanaGibraltarGreeceGreenlandGrenadaGuadeloupeGuatemalaGuernseyGuineaGuinea-BissauGuyanaHaitiHeard Island and McDonald IslandsHondurasHong KongHungaryIcelandIndiaIndonesiaIranIraqRepublic of IrelandIsle of ManIsraelItalyIvory CoastJamaicaJapanJerseyJordanKazakhstanKenyaKiribatiKuwaitKyrgyzstanLaosLatviaLebanonLesothoLiberiaLibyaLiechtensteinLithuaniaLuxembourgMacao S.A.R., ChinaMacedoniaMadagascarMalawiMalaysiaMaldivesMaliMaltaMarshall IslandsMartiniqueMauritaniaMauritiusMayotteMexicoMicronesiaMoldovaMonacoMongoliaMontenegroMontserratMoroccoMozambiqueMyanmarNamibiaNauruNepalNetherlandsNetherlands AntillesNew CaledoniaNew ZealandNicaraguaNigerNigeriaNiueNorfolk IslandNorth KoreaNorwayOmanPakistanPalestinian TerritoryPanamaPapua New GuineaParaguayPeruPhilippinesPitcairnPolandPortugalQatarReunionRomaniaRussiaRwandaSaint BarthélemySaint HelenaSaint Kitts and NevisSaint LuciaSaint Martin (French part)Saint Martin (Dutch part)Saint Pierre and MiquelonSaint Vincent and the GrenadinesSan MarinoSão Tomé and PríncipeSaudi ArabiaSenegalSerbiaSeychellesSierra LeoneSlovakiaSloveniaSolomon IslandsSomaliaSouth AfricaSouth Georgia/Sandwich IslandsSouth KoreaSouth SudanSpainSri LankaSudanSurinameSvalbard and Jan MayenSwazilandSwedenSwitzerlandSyriaTaiwanTajikistanTanzaniaThailandTimor-LesteTogoTokelauTongaTrinidad and TobagoTunisiaTurkeyTurkmenistanTurks and Caicos IslandsTuvaluUgandaUkraineUnited Arab EmiratesUruguayUzbekistanVanuatuVaticanVenezuelaVietnamWallis and FutunaWestern SaharaWestern SamoaYemenZambiaZimbabweTelephoneMobile Phone *How do you know about this Promo? *AA ConnectionsFacebookFlyerMagazineOutdoor BannerRoadshowSMS BroadcastStraits Times NewspaperTele-marketingTODAY NewspaperSearch EngineOnline AdsLianhe ZaobaoOthersOthers, please specify MEMBER-GET-MEMBER (MGM) PROGRAMMEI have been referred by a friend who is a valid member.Referrer’s Name ( If applicable )Referrer’s Membership No. ( If applicable )By providing the above information, you have agreed to be recommended by your referrer who may qualify for AA MGM Programme. Click here for the Terms and Conditions of the programme. DECLARATION & AUTHORISATION *I agree to the below Declaration & Authorisation Details on Declaration & Authorisation I have read and agree unconditionally to be bound by AA’s Constitution, Terms and Conditions, Service Policy and Privacy Policy. I understand that AA reserves the right to reject any application in its sole discretion without giving any reasons. I certify that the particulars and information furnished herein are true and accurate. I understand that RAS is handled by AA’s subsidiary, AutoSwift Recovery Pte Ltd (“ASR”). I consent to ASR accessing, collecting, using and disclosing my personal information for the purpose of verifying my identity and membership with AA and in connection with the carrying out of such RAS. I also consent to ASR communicating with me for the purposes of carrying out the RAS. In order for me to enjoy insurance services available to AA Members, I consent to AAS Insurance Agency, a subsidiary of AA and its partners, assessing, collecting, using and disclosing my personal information which I have furnished to AA. I also authorise and give consent to AAS-Insurance Agency and its partners to communicate with me via post , email, SMS text messaging and/or telephone on any insurance product, service, benefit and /or promotion. When I participate in any contests, activities or events organised by AA, I authorise and give consent to AA, its subsidiaries and partners to use photographs and/or video images taken at contests, activities or events in which I have been captured. The image(s) may be published in any of AA’s communication materials and collaterals and also in connection with any of AA’s business partners' publicity purposes. 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