ClubBrezza Membership Application Form
I hereby make application to join the ClubBrezza.com initiated & formed by (MBERG) Millennium Business & Entrepreneurship Resource Group Incorporated as Society membership. SIGN ME UP!
Email address *
Welcome to ClubBrezza
Membership Option *
Name *
Your answer
Gender *
Nationality *
Languages you speak or know *
Your answer
Date of Birth
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DD
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YYYY
Your Blood Group *
Your answer
Mobile Number *
Your answer
Your Linkedin Profile, If any. *
Your answer
Address (Communication Address) This will be your location on VBOC Map too. *
Your answer
City *
Your answer
State *
Your answer
Pincode *
Your answer
Profession ( What do you do) Please state your business type, employer name & company name *
Your answer
Industry *
Your answer
Designation *
Your answer
I will like to Network with other members. I authorise VBOC to share my profession with other members.
Marital Status *
Spouse Name
Your answer
Spouse Profession (If unmarried please write NA) *
Your answer
Cars in Family
Your answer
Please write down all your Hobbies, Interests *
Your answer
Mention the best road trip/s (Max 2 Trips) you have had in India, and when?
Your answer
Please specify the next destination you are planning for & when? Also specify if you have planned with family or alone.
Your answer
Do you wish to be your City Lead for VBOC? A City Lead will lead his city members with other leads, manage all club activities in sync with the Core Team & will represent VBOC in his respective city. *
Please state colour your Brezza? (When u Bought it) *
Please state colour your Brezza Variant (Brezza as you bought it) *
Date of Purchase of Vitara Brezza *
MM
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DD
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YYYY
Current Insuring Company: *
Please state your Car Registration number. If you are awaiting submit later & write below your STC & RTO Code. Example: STATE TRANSPORT CODE: HR RTO CODE: 26. So write HR 26 *
Your answer
Please state your Membership payment details? Please write amount you paid, When did you pay & How did you pay along with a transaction number. *
Your answer
Additional Comments or Requirements.
Your answer
A copy of your responses will be emailed to the address you provided.
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