Individual Membership Application Form
Full Name: *
Your answer
Gender *
Your answer
NRIC/Passport/FIN: *
Your answer
Nationality *
Your answer
Mobile No: *
Your answer
Email: *
Your answer
Date of birth (dd/mm/yy): *
Your answer
Mailing Address
Your answer
Preferred Language
Your answer
I hereby give consent to VIGNE, its associated persons/ organisations, and their independent third party service providers and their representatives, within Singapore to collect, use, disclose, store, retain and/or process all personal data and information (“Personal Data”), that had/ have been provided for the purpose of marketing and promotional information relating to existing or future products and/or services, by mail, electronic transmission through email address and/or social media accounts, communication through mobile device(s) e.g SMS, Whatsapp, voice call, etc. Which are in VIGNE’s records, and may be updated from time to time by notice to VIGNE PersonsI may withdraw one or more consents provided by me at anytime via VIGNE Healthcare Hotline at 6509 0030 or email at hc@vigne.com.sg. I will stop receiving marketing messages via the selected mode of communication after 30 days. I will continue to receive marketing messages via other modes of communication where my consent has been given and information arising from my VIGNE programmes. The consent provided by me in this form is in addition to and does not supersede, vary or nullify any consent, which I may have provided previously in respect of the above purposes, unless my consent is withdrawn in the manner specified by VIGNE. *
Required
How did you get to know VIGNE? *
Referred by *
Your answer
Submit
Never submit passwords through Google Forms.
This content is neither created nor endorsed by Google. Report Abuse - Terms of Service - Additional Terms