Membership Listing

ជ្រើសរើសសមាជិក :

សមាជិកធម្មតា

សមាជិកជាគ្រួសារ

សមាជិកជាក្រុមហ៊ុន

សមាជិកធម្មតា

Salution:

Mr Mrs Ms Mdm

Name as in NRIC/Passport (underline surname) : Email : Nationality: Name to appear on card (max 33 characters) : Tel: HP : Occupation : Driving License No: Driving License Class: Address: Post Code: Birthday:

Marital Status :

Single Married Devorce

Gender :

Do you own a car?

If Yes Your Car Plate No :

Make / Model :

Year of Manufacue :

I accept the registration terms & conditions

សមាជិកជាគ្រួសារ

Name as in NRIC/Passport (underline surname) : Name to appear on card (max 33 characters) : Nationality: Email : Tel: HP : Occupation : Driving License No : Driving License Class: Address: Post Code:

Marital Status :

Single Married Devorce

Gender :

Do you own a car?

Do you own a car? :

Make / Model :

Year of Manufacture :

I accept the registration terms & conditions

សមាជិកជាក្រុមហ៊ុន

Name as in NRIC/Passport (underline surname) : Name to appear on card (max 33 characters) : Nationality: Email : Tel: HP : Occupation : Driving License No : Driving License Class: Address: Post Code:

Marital Status :

Single Married Devorce

Gender :

Do you own a car?

Do you own a car? :

Make / Model :

Year of Manufacture :

I accept the registration terms & conditions

Membership Fees

Type	1-Time Fee	Term	Fee US	Total Fee
Ordinary	$19	1 Year	$49	$68
		3 Years	$147	$156
		5 Years	$245	$250Only 52 p.a.
Family	-	1 Year	$19	$19
		3 Years	$50	$50Only 16.67 p.a.
		5 Years	$80	$80Only 26.67 p.a.
Corperate(Min. 2 cars)	$80	1 Year	$65 Each of the first 2 registered cars	N.A. Total fee varies
Corperate(Min. 2 cars)	$80	1 Year	$35 Each additional car	N.A. Total fee varies

Payment

Preferences By Cash USD By Cheque USD (Payable to “Automobile Association of Cambodia”)

FOR MEMBER-GET-MEMBER PROGRAMME

Name of Introducer : NRIC / of Introducer : Email :

Color photo for card

Upload

Please allow 14 working days for your permanent card to be processed.