Copperleaf Elite Club

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LOYALTY MEMBERSHIP PROGRAM

To apply for loyalty program, please complete all required questions.

CLFRMCECLOYMEM | Ver: 2023.04.14.00

Salutation *

First Name *

Last Name *

Mobile Number *

Email *

Address Line 1 *

Address Line 2 *

Address Line 3 *

Landmark *

City *

State *

Country *

Pincode *

Birthdate *

We ask for birthdate to confirm you are above 18 years of age. We also use this date to provide birthday incentives. Birthdate is a required field for us to process your application.

YYYY

Anniversary Date

Anniversary date is required, if you would like to receive Anniversary Incentive. Kindly provide your anniversary date if you are married. We may ask for documentary proof to confirm this date. Skip the question if it's not applicable for you.

YYYY

Gender *

Male

Female

Rather not to say

Select Your Membership Tier *

SILVER (5,000/- Yearly Membership Fee + GST)

GOLD (25,000/- Yearly Membership Fee + GST)

PLATINUM (50,000/- Yearly Membership Fee + GST)

IVORY Professional For Doctors (10,000/- Yearly Membership Fee + GST)

BLACK Professional For Lawyers (10,000/- Yearly Membership Fee + GST)

INDIGO Professional For CAs (10,000/- Yearly Membership Fee + GST)

GREEN Professional For Teachers (10,000/- Yearly Membership Fee + GST)

I Agree *

By participating in the Copperleaf Elite Club (CEC) Loyalty Program, members agree to the terms and conditions of this program. I am aware that this program has annual membership fees as per the tier I select.

Required

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