Apply to become an Elite Member Spam protection, skip this field First Name* Last Name* Middle Name (optional) Email Address* Phone Number* Nationality* Nationality Afghanistan Albania Algeria Argentina Australia Austria Bangladesh Belgium Bolivia Botswana Brazil Bulgaria Cambodia Cameroon Canada Chile China Colombia Costa Rica Croatia Cuba Czech Republic Denmark Dominican Republic Ecuador Egypt El Salvador England Estonia Ethiopia Fiji Finland France Germany Ghana Greece Guatemala Haiti Honduras Hungary Iceland India Indonesia Iran Iraq Ireland Israel Italy Jamaica Japan Jordan Kenya Kuwait Laos Latvia Lebanon Libya Lithuania Madagascar Malaysia Mali Malta Mexico Mongolia Morocco Mozambique Namibia Nepal Netherlands New Zealand Nicaragua Nigeria Norway Pakistan Panama Paraguay Peru Philippines Poland Portugal Romania Russia Saudi Arabia Scotland Senegal Serbia Singapore Slovakia South Africa South Korea Spain Sri Lanka Sudan Sweden Switzerland Syria Taiwan Tajikistan Thailand Tonga Tunisia Turkey Ukraine United Arab Emirates (The) United Kingdom (The) United States Uruguay Venezuela Vietnam Wales Zambia Zimbabwe Current Location* Location Inside Thailand Outside Thailand If you were in Thailand, please select what province you are in (optional) Select Province Bangkok Amnat Charoen Ang Thong Bueng Kan Buriram Chachoengsao Chainat Chaiyaphum Chanthaburi Chiang Mai Chiang Rai Chonburi Chumphon Kalasin Kamphaeng Phet Kanchanaburi Khon Kaen Krabi Lampang Lamphun Loei Lopburi Mae Hong Son Maha Sarakham Mukdahan Nakhon Nayok Nakhon Pathom Nakhon Phanom Nakhon Ratchasima Nakhon Sawan Nakhon Si Thammarat Nan Narathiwat Nong Bua Lamphu Nong Khai City Nonthaburi Pathum Thani Pattani Phang Nga Phatthalung Phayao Phetchabun Phetchaburi Phichit Phitsanulok Phra Nakhon Si Ayutthaya Phrae Phuket Prachinburi Prachuap Khiri Khan Ranong Ratchaburi Rayong Roi Et Sa Kaeo Sakon Nakhon Samut Prakan Samut Sakhon Samut Songkhram Saraburi Satun Sing Buri Sisaket Songkhla Sukhothai Suphan Buri Surat Thani Surin Tak Trang Trat Ubon Ratchathani Udon Thani Uthai Thani Uttaradit Yala Yasothon Your Preferred Program* Select a Program 5 Years GOLD membership 10 Years PLATINUM membership 15 Years DIAMOND membership Undecided Residential Address Please provide either a home country address or a Thailand address. Please write complete address include, district, city, province, etc. Your current Thai visa or latest entry stamp to Thailand Select Current Visa I don't have a VISA I am holding a Tourist VISA I am holding an Education VISA I am holding Business VISA Others (Volunteer Visa holder are not applicable) If you have a visa, please provide place of issue and expiry date: (optional) Some visa issued from Thai Embassy are not allowed to cancel within Thailand. Applicant have at least 3 empty pages in my passport (not include endorsement page)* Please select one Yes No Others Where would you prefer to affix your Elite visa? (this is not a confirmation of your option) (optional) Please Select Upon Arriving at Suvarnabhumi Airport Upon Arriving at Phuket Airport Chaeng Wattana Immigration Office Thai Embassy in your passport issuing country Do you own a property in Thailand? (optional) Please select one Yes No Planning to purchase one Have you ever overstay in Thailand for more than once?* Please select one Yes No 2 or more times Not sure Who is applying? Myself My spouse My children Others Expiration date of your current passport* When do you plan to obtain your Elite Visa? (optional) Upload Application Form (optional) Choose file Uploading… (0%) Browse Oops. This file type isn’t allowed. This file size is too big. Download the Application from the 'Membership' page, print out and fill up the required detail and sign. Signature must be the same one as in your passport copy Please Note: Supported files to are: .jpg, .jpeg, .bmp, .gif, .png, .pdf, .docx, .doc. Upload Passport (optional) Passport copy page with signature Uploading… (0%) Browse Oops. This file type isn’t allowed. This file size is too big. Scan or take photo of all pages and upload here. Full page with all detail visible. Please note: the file size limits for file upload fields are 100MB for a single file and 500MB in total for multiple files. Supported files to are: .jpg, .jpeg, .bmp, .gif, .png, .pdf, .docx, .doc. In case the files are more than the limit, please use file sharing field below. File Sharing URL/Link (optional) Provide the Dropbox/Google Drive/WeTransfer or other File Sharing Link or URL inside the box if the upload file size are more than 500MB. Upload Photo (optional) Choose file Uploading… (0%) Browse Oops. This file type isn’t allowed. This file size is too big. High Resolution Photo (Photo with blue or white background only) Please Note: Supported files to are: .jpg, .jpeg, .bmp, .gif, .png, .pdf, .docx, .doc. Requirements to Enroll an Immediate Family Member (optional) Upload Marriage Certificate (Family Applicant Only) (optional) Choose file Uploading… (0%) Browse Oops. This file type isn’t allowed. This file size is too big. For uploading of Passport copy, Application Form, other relevant document only. Please Note: Supported files to are: .jpg, .jpeg, .bmp, .gif, .png, .pdf, .docx, .doc. Child Birth Certificate (Child Applicant Only) (optional) Choose file Uploading… (0%) Browse Oops. This file type isn’t allowed. This file size is too big. Please Note: Supported files to are: .jpg, .jpeg, .bmp, .gif, .png, .pdf, .docx, .doc. Others (optional) Choose file Uploading… (0%) Browse Oops. This file type isn’t allowed. This file size is too big. Please Note: Supported files to are: .jpg, .jpeg, .bmp, .gif, .png, .pdf, .docx, .doc. I hereby giving consent for a clearance check should I have uploaded my copy of passport. You will expect to receive a letter of approval with payment detail of membership fee in due time. I agree to receiving marketing and promotional materials. Validate your submission
