FullReg.

HN紫燕品質名天下HN

HN極品燕窩第一家HN

紫燕俱樂部登記表

您所提供的資料只供紫燕更好的為您服務﹐決不會泄露與任何第三者﹐因為紫燕絕對尊重您的個人隱私及權益，將會妥善保管您所提供的一切資料。

-如您希望註冊成為新用戶，在提交此表格後，必須交付$15會員費及$3手續費。否則我們無法處理您的申請。謝謝。

您也可以用此表格來更新您的會員資料﹐謝謝。

Screen Information

Create your HealthyClub User Name.
<-- The name to sign in HealthyClub.
Choose your Password:

Re-enter your Password again for verification:
<-- Make sure it's the same as Password.

Personal Information

This information will helps us to better understand the types of people who use HealthyClub, and to better serve our HealthyMember. The information you provided here will be used exclusively by HealthyNest and will not be disclosed to any third party.

Required:
Your First Name:		Your Last Name:
Gender:		Location:
Email Address:
Phone Number:*	-
*Please include your country code and area code, thanks.
Your Birthday:	Month Day
Yes, I would like to receive further newsletter from HealthyNest.

Optional:
Occupation:		Company:

In case you forget your password
If you forget your password, you'll be asked a questions you specified below. We'll send you a new password to the email address you provide above, so make sure it is correct.
Your Question:
Your Answer:

Is this new registration or an update of your membership:
Please select:
If this is an update, please include your card's number on the back of your member card
Your card number:	--

-如您希望註冊成為新用戶，在提交此表格後，必須交付$15會員費及$3手續費。否則我們無法處理您的申請。謝謝。