Name *

First Name

Last Name

Phone *

Country

(###)

###

####

Date of Birth *

MM

DD

YYYY

Gender *

Male

Female

Have you been part of other private networks or membership clubs? *

Yes

No

Can you commit to a 12-month membership term? *

Yes

No

Are you able to attend at least one Prestige event per quarter? *

Yes

No

Declaration *

• I confirm that the information provided is accurate. • I agree to abide by the Prestige Way (Code of Conduct / Subscription & Payment Policy). • I understand that membership applications are reviewed and acceptance is not guaranteed.

Yes

Date

MM

DD

YYYY